Danni Lu1,2, Maria S Altieri3, Jie Yang4, Donglei Yin5, Nabeel Obeid6, Konstantinos Spaniolas3, Mark Talamini3, Aurora D Pryor3. 1. Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA. Danni.Lu@stonybrookmedicine.edu. 2. , Mineola, USA. Danni.Lu@stonybrookmedicine.edu. 3. Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA. 4. Department of Family, Population and Preventive Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA. 5. Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA. 6. Division of Minimally-Invasive Surgery, Department of Surgery at Michigan Medicine, Ann Arbor, USA.
Abstract
BACKGROUND: Little is known of the natural history of fundoplication or paraesophageal hernia (PEH) repair in terms of reoperation or the incidence treatment of postsurgical gastroparesis (PSG) in large series. Repeat fundoplications or PEH repairs, as well as pyloroplasty/pyloromyotomy operations, have proven to be effective in the context of PSG or recurrence. In this study, we analyzed the incidences of PSG and risk factors for these revisional surgeries following fundoplication and PEH repair procedures in the state of New York. METHODS: The New York State Planning and Research Cooperative System (NY SPARCS) database was utilized to examine all adult patients who underwent fundoplication or PEH repair for the treatment of GERD between 2005 and 2010. The primary outcome was the incidence of each type of reoperation and the timing of the follow-up procedure/diagnosis of gastroparesis. Generalized linear mixed models were used to examine the risk factors for follow-up procedures/diagnosis. RESULTS: A total of 5656 patients were analyzed, as 3512 (62.1%) patients underwent a primary fundoplication procedure and 2144 (37.9%) patients underwent a primary PEH repair. The majority of subsequent procedures (n = 254, 65.5%) were revisional procedures (revisional fundoplication or PEH repair) following a primary fundoplication. A total of 134 (3.8%) patients who underwent a primary fundoplication later had a diagnosis of gastroparesis or a follow-up procedure to treat gastroparesis, while 95 (4.4%) patients who underwent a primary PEH repair were later diagnosed with gastroparesis or underwent surgical treatment of gastroparesis. CONCLUSION: The results revealed low reoperation rates following both fundoplication and PEH repairs, with no significant difference between the two groups. Additionally, PEH repair patients tended to be older and were more likely to have a comorbidity compared to fundoplication patients, particularly in the setting of hypertension, obesity, and fluid and electrolyte disorders. Further research is warranted to better understand these findings.
BACKGROUND: Little is known of the natural history of fundoplication or paraesophageal hernia (PEH) repair in terms of reoperation or the incidence treatment of postsurgical gastroparesis (PSG) in large series. Repeat fundoplications or PEH repairs, as well as pyloroplasty/pyloromyotomy operations, have proven to be effective in the context of PSG or recurrence. In this study, we analyzed the incidences of PSG and risk factors for these revisional surgeries following fundoplication and PEH repair procedures in the state of New York. METHODS: The New York State Planning and Research Cooperative System (NY SPARCS) database was utilized to examine all adult patients who underwent fundoplication or PEH repair for the treatment of GERD between 2005 and 2010. The primary outcome was the incidence of each type of reoperation and the timing of the follow-up procedure/diagnosis of gastroparesis. Generalized linear mixed models were used to examine the risk factors for follow-up procedures/diagnosis. RESULTS: A total of 5656 patients were analyzed, as 3512 (62.1%) patients underwent a primary fundoplication procedure and 2144 (37.9%) patients underwent a primary PEH repair. The majority of subsequent procedures (n = 254, 65.5%) were revisional procedures (revisional fundoplication or PEH repair) following a primary fundoplication. A total of 134 (3.8%) patients who underwent a primary fundoplication later had a diagnosis of gastroparesis or a follow-up procedure to treat gastroparesis, while 95 (4.4%) patients who underwent a primary PEH repair were later diagnosed with gastroparesis or underwent surgical treatment of gastroparesis. CONCLUSION: The results revealed low reoperation rates following both fundoplication and PEH repairs, with no significant difference between the two groups. Additionally, PEH repair patients tended to be older and were more likely to have a comorbidity compared to fundoplication patients, particularly in the setting of hypertension, obesity, and fluid and electrolyte disorders. Further research is warranted to better understand these findings.
Authors: Nabeel R Obeid; Maria S Altieri; Jie Yang; Jihye Park; Kristie Price; Andrew Bates; Aurora D Pryor Journal: Surg Endosc Date: 2017-07-13 Impact factor: 4.584