Two-year subjective, objective, quality of life, and endoscopic follow-up after laparoscopic Nissen-Rossetti in patients with columnar-lined esophagus.

INTRODUCTION: Barrett esophagus (BE) is a complication of gastroesophageal reflux disease. We wish to determine the effects of surgery on the histology of the esophageal mucosa and evaluate Quality of Life. MATERIALS AND METHODS: Twenty-seven patients with columnar-lined esophagus (CLE) metaplasia underwent laparoscopic Nissen-Rossetti fundoplication. Patients were submitted to close follow-up. RESULTS: One patient voluntarily left follow-up after surgery. CLE was still present in 18 patients (66.6%); no patient developed dysplasia or esophageal adenocarcinoma. Two patients with gastric metaplasia and 1 patient with intestinal metaplasia had regression at 12 and 24 months after surgery (11.1%). DeMeester and Johnson score decreased from 38.69 (SD ± 51.44) to 11.99 (SD ± 18.08) at 6 months, 12.69 (SD ± 12.91) at 12 months, and it was 11.38 (SD ± 6.43) at 24 months. Preoperative gastroesophageal reflux disease-health related quality of life was 19.90 (SD ± 18.54), 9.80 (SD ± 8.77) at 6 months, 9.57 (SD ± 9.14) at 12 months, and 11.53 (SD ± 6.48) at 24 months. Short form-36 measurement showed significant improvement. CONCLUSIONS: Management of CLE requires multidisciplinary approach. Medical therapy does not prevent biliary reflux into the esophagus. Surgical therapy is effective and long lasting. It should be performed by experienced surgical teams.

An unexpected case of giant hiatal hernia and review of literature. GHH: case report and literature review.

INTRODUCTION: The management of giant hiatal hernia remains one of the most complicated surgical challenge and several operative approaches have been proposed during the years. Currently, the most practiced is the laparoscopic approach, which adds functional outcomes overlapping those of the conventional open surgery to the own advantages of the technique. The main problem of this operation is the high rate of recurrence, occurring independently by the specific technique adopted. PRESENTATION OF CASE: An unexpected case of giant hiatal hernia, incidentally discovered in a patient candidate to cholecystectomy for gallstones, is presented. We describe the surgical procedure performed and our cornerstones for a correct and long-lasting hiatal hernia repair, comparing us with the current standards of care. DISCUSSION: Laparoscopy has facilitated the execution of some surgical steps, such as the hiatal visualization and the intra-thoracic esophagus mobilization, fundamental for the success of the operation. Inheriting the concept of tension free repair, the use of mesh reinforcing the hiatal defect is being encouraged, especially biologic meshes, although some authors warn their employment may introduce potential catastrophic complications for patient. CONCLUSION: Laparoscopy should be the approach of choice, whenever possible, to treat this condition, while the use of supportive prosthetic devices depends on the single patient's hernia characteristics and on the surgeon's personal experience and preferences. Anyways, many factors determine the final outcomes of the surgical intervention, some of which patient dependent, others operator-dependent but, independently from the approach adopted, this operation is often burdened by a high risk of recurrence.

Quality of life after Nissen-Rossetti fundoplication.

BACKGROUND: We investigated Quality of Life (QoL) and Johnsson & DeMeester score of patients after Nissen-Rossetti fundoplication. MATERIALS AND METHODS: From January 2007 to June 2008, 43 patients with chronic gastroesophageal reflux underwent laparoscopic Nissen-Rossetti fundoplication; 7 were lost during the follow-up. Patients underwent endoscopy, 24-hour pH-metry, Gastroesophageal Reflux Disease-Health-Related Quality-of-Life (GERD-HRQL), and Short Form 36 (SF-36) questionnaires preoperatively, 6 months, and 12 months after surgery. RESULTS: Endoscopic findings revealed complete healing of esophagitis in all patients. Barrett esophagus was still present. Six patients reported persistence of symptoms but postoperative pH-metry and endoscopy showed the absence of reflux; 2 patients (5.5%) were still on proton pump inhibitor therapy at 12 months. Seven patients (19.4%) reported dysphagia for solids for at least 3 months. Readmission for dysphagia was required for 2 (5.5%) and 1 patient underwent endoscopic dilatation. At 6 and 12 months, no dysphagia was reported. During the follow-up, no gas-bloat syndrome was reported. The Johnsson & DeMeester score and QoL measurement obtained from GERD-HRQL and SF-36 revealed a significant improvement in the related domain. At 6 months, 23 patients (63.8%) were completely satisfied and after 12 months, 30 patients (83.3%) were satisfied. CONCLUSIONS: Nissen-Rossetti fundoplication is safe and effective for the treatment of GERD, improving QoL.

Laparoscopic Nissen-Rossetti fundoplication for gastroesophageal reflux disease patients after 2-year follow-up.

INTRODUCTION: Gastroesphageal reflux disease (GERD) is a common condition in the general population, affecting patients' quality of life and predisposing to Barrett's esophagus and its most fearsome complication, esophageal adenocarcinoma. The aim of this study is to compare objective and subjective outcomes of laparoscopic Nissen-Rossetti fundoplication after 2 years of follow-up. SUBJECTS AND METHODS: Seventy-six GERD patients underwent laparoscopic Nissen-Rossetti fundoplication. Patients were subjected to close follow-up. RESULTS: The DeMeester and Johnson score average decreased from a mean preoperative value of 35.48 (SD±40.24) to 9.83 (SD±6.40) at 6 months; at 12 months it was 11.44 (SD±10.28), and at 24 months it was 10.25 (SD±5.61). GERD Health-Related Quality of Life decreased from a preoperative value of 23.04 (SD±11.59) to 9.84 (SD±8.98) at 6 months, 8.34 (SD±8.98) at 12 months, and 6.8 (SD±6.46) at 24 months. The Short Form-36 measurement showed significant improvement. CONCLUSIONS: GERD patients need adequate reflux control. Successful antireflux surgery is more effective than medical therapy in preventing both acid and bile reflux. Surgical therapy is effective in terms of reflux control and improvement in quality of life. Strict and rigorous follow-up with both subjective and objective tests is important in order to identify asymptomatic recurrence of reflux after surgery.

Partial or total fundoplication (with or without division of the short gastric vessels): which is the best laparoscopic choice in GERD surgical treatment?

BACKGROUND: Gastroesophageal reflux disease (GERD) has emerged as one of the most common diseases in the modern civilization.The immense success of laparoscopic surgery as an effective treatment of GERD has established the minimally invasive surgery as the gold standard for this condition with lower morbidity and mortality, shorter hospital stay, faster recovery, and reduced postoperative pain. METHODS: Articles were sourced from PubMed and Medline, using the MeSH terms "gastroesophageal reflux disease" and "laparoscopic surgery" and "fundoplication technique." The selection of articles was based on peer review, journal, relevance, and English language. RESULTS AND CONCLUSIONS: There are some controversies with regard to the technique. First, whether total or partial fundoplication is the more appropriate treatment for GERD; second, if a total fundoplication (360 degrees) is performed, what is the effect of fundic mobilization and the division of short gastric vessels. In this review article the authors evaluate the most recent articles to establish the parameters for a "gold standard technique" in antireflux surgery.

Selection criteria for surgery in patients with obstructed defecation, rectocele and anorectal prolapse.

The aim of this study was to evaluate the impact of applying strict selection criteria to patients with symptoms of obstructed defecation, rectocele and rectal prolapse who were candidates for surgery. From June 2001 to September 2003, 20 patients underwent surgery in our clinic for symptomatic rectocele and anorectal prolapse. They were evaluated prospectively using a dedicated questionnaire (KESS), a proctological and gynaecological examination, colpo-cysto-defecography and anorectal manometry before surgery and 6 months postoperatively. Strict selection criteria were used for surgery. After 6 months the questionnaire showed an important improvement in symptoms. The symptoms of obstructed defecation and vaginal bulging improved significantly. The average KESS score dropped from 17.65 preoperatively to 5.8 six months after surgery. In the treatment of pelvic floor disease, it is important to evaluate both the uro-gynaecological and the proctological symptoms with the utmost care, obtaining an accurate clinical picture with the aid of dedicated questionnaires and a thorough clinical examination. Evaluation of the effectiveness of surgery for constipation necessarily includes assessing the strength of the indications for surgery, irrespective of the surgical technique adopted, but there is currently no standardised test method for recording and comparing the symptoms of constipation.

Colitis cystica profunda of the rectum: report of a case and review of the literature.

Colitis cystica profunda is a rare intestinal lesion. Because of its clinical expression (rectorrhagia, mucorrhea and abdominal pain) and the way it appears to current imaging techniques this disease presents features which can be associated with colon neoplasm. Its diagnosis has to be confirmed histologically, and its etiology remains unclear. The following is a case report of colitis cystica profunda recurring 20 years after a first episode in a white woman, who had had an anterior resection of the sigmoid colon and upper rectum to deal with a colitis cystica profunda-induced stenosis of the sigmoid colon and at 41 underwent the transanal removal of a polypoid lesion. A review of 20 cases in the literature showed that colitis cystica profunda has a predilection for the male and generally affects the medial and lower rectum and the sigmoid colon. The literature also confirmed the association with ulcerative rectocolitis, Crohn's disease and rectal prolapse. The type of treatment varies from surgical, medical, and endoscopic to no treatment at all.