Edno Tales Bianchi1, Paulo Francisco Guerreiro Cardoso2, Helio Minamoto3, Benoit Jacques Bibas3, Michele Salati4, Paulo Manuel Pego-Fernandes3. 1. Department of Gastroenterology, Discipline of Surgery of the Digestive Tract, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo-SP, Brazil. 2. Division of Thoracic Surgery, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo-SP, Sao Paulo, Brazil. Electronic address: cardosop@gmail.com. 3. Division of Thoracic Surgery, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo-SP, Sao Paulo, Brazil. 4. Division of Thoracic Surgery, University of Ancona, Ancona, Italy.
Abstract
OBJECTIVE: This study focuses on the impact of antireflux surgery in the outcome of tracheal stenosis. METHODS: We performed a retrospective study including patients with benign tracheal stenosis who underwent esophageal manometry and dual-probe 24-hour ambulatory esophageal pH study. Patients with an abnormal pH study were managed with laparoscopic modified Nissen fundoplication or medically (omeprazole 80 mg/d, orally). Patients with normal pH study results were observed. After a 24-month follow-up, the outcome was considered satisfactory if tracheal stenosis could be managed by resection and there was no need for further dilatation or definitive decannulation. The management groups were compared using propensity score matching. RESULTS: A total of 175 patients were included. Abnormal pH study results were found in 74 patients (42.3%), and 12.6% of patients had typical gastroesophageal reflux symptoms. Follow-up was completed in 124 patients (20 had fundoplication, 32 received omeprazole, and 72 were observed). After propensity score matching, the outcome of tracheal stenosis in the fundoplication group was similar to that of the observation group (odds ratio, 1; P = .99) and better than that of the omeprazole group (odds ratio, 5.31; P = .03). The observation (no gastroesophageal reflux) group had a better outcome of stenosis than those treated with omeprazole (odds ratio, 3.54; P = .02). CONCLUSIONS: The outcome of the airway stenosis was superior after laparoscopic fundoplication compared with medical treatment with omeprazole and was similar to the outcome of patients without gastroesophageal reflux. A prospective randomized trial is warranted.
OBJECTIVE: This study focuses on the impact of antireflux surgery in the outcome of tracheal stenosis. METHODS: We performed a retrospective study including patients with benign tracheal stenosis who underwent esophageal manometry and dual-probe 24-hour ambulatory esophageal pH study. Patients with an abnormal pH study were managed with laparoscopic modified Nissen fundoplication or medically (omeprazole 80 mg/d, orally). Patients with normal pH study results were observed. After a 24-month follow-up, the outcome was considered satisfactory if tracheal stenosis could be managed by resection and there was no need for further dilatation or definitive decannulation. The management groups were compared using propensity score matching. RESULTS: A total of 175 patients were included. Abnormal pH study results were found in 74 patients (42.3%), and 12.6% of patients had typical gastroesophageal reflux symptoms. Follow-up was completed in 124 patients (20 had fundoplication, 32 received omeprazole, and 72 were observed). After propensity score matching, the outcome of tracheal stenosis in the fundoplication group was similar to that of the observation group (odds ratio, 1; P = .99) and better than that of the omeprazole group (odds ratio, 5.31; P = .03). The observation (no gastroesophageal reflux) group had a better outcome of stenosis than those treated with omeprazole (odds ratio, 3.54; P = .02). CONCLUSIONS: The outcome of the airway stenosis was superior after laparoscopic fundoplication compared with medical treatment with omeprazole and was similar to the outcome of patients without gastroesophageal reflux. A prospective randomized trial is warranted.
Authors: Paulo Francisco Guerreiro Cardoso; Helio Minamoto; Benoit Jacques Bibas; Paulo Manuel Pego-Fernandes Journal: Transl Cancer Res Date: 2020-03 Impact factor: 1.241
Authors: Benoit Jacques Bibas; Paulo Francisco Guerreiro Cardoso; Helio Minamoto; Paulo Manoel Pêgo-Fernandes Journal: Transl Cancer Res Date: 2020-03 Impact factor: 1.241