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Laparoscopic Partial Sleeve Gastrectomy with Fundoplication for Gastroesophageal Reflux and Delayed Gastric Emptying

Background A difficult management problem for the upper gastrointestinal surgeon exists when a patient presents with symptomatic and refractory severe delayed gastric emptying. Surgical treatment is further complicated by coexisting gastro-oesophageal reflux. No universal surgical strategy exists fo...

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Published in:World journal of surgery 2015-06, Vol.39 (6), p.1460-1464
Main Authors: Le Page, Philip A., Martin, David
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description Background A difficult management problem for the upper gastrointestinal surgeon exists when a patient presents with symptomatic and refractory severe delayed gastric emptying. Surgical treatment is further complicated by coexisting gastro-oesophageal reflux. No universal surgical strategy exists for this problem. Methods A novel surgical strategy combines partial sleeve gastrectomy (SG) and hiatus hernia (HH) repair with fundoplication. A review of treating four such patients is described with objective outcome data. Results Overall, solid gastric emptying improved in all, from median 350 (163–488) min pre-operatively to 108 (84–135) at 10 months (3–24) post-operatively, corresponding to 67 % improvement. Primary symptoms resolved in all; however, one patient had recurrent symptoms. GERD-HRQL also improved in all, from median 23 (3–25) to 4 (0–8) at 21 months (6–30, 83 % improvement). Gas bloat improved in three. All had post-operative gastroscopies showing intact repair and absent oesophagitis, with no patient requiring post-operative PPI. Patient weight reduced by median 11 % (7–20) post-operatively. There was no significant peri-operative morbidity. Conclusions With careful patient selection and work-up, SG and HH repair with fundoplication may improve quality of life by coupling adequate reflux control with improved gastric emptying.
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Surgical treatment is further complicated by coexisting gastro-oesophageal reflux. No universal surgical strategy exists for this problem. Methods A novel surgical strategy combines partial sleeve gastrectomy (SG) and hiatus hernia (HH) repair with fundoplication. A review of treating four such patients is described with objective outcome data. Results Overall, solid gastric emptying improved in all, from median 350 (163–488) min pre-operatively to 108 (84–135) at 10 months (3–24) post-operatively, corresponding to 67 % improvement. Primary symptoms resolved in all; however, one patient had recurrent symptoms. GERD-HRQL also improved in all, from median 23 (3–25) to 4 (0–8) at 21 months (6–30, 83 % improvement). Gas bloat improved in three. All had post-operative gastroscopies showing intact repair and absent oesophagitis, with no patient requiring post-operative PPI. Patient weight reduced by median 11 % (7–20) post-operatively. There was no significant peri-operative morbidity. Conclusions With careful patient selection and work-up, SG and HH repair with fundoplication may improve quality of life by coupling adequate reflux control with improved gastric emptying.</description><identifier>ISSN: 0364-2313</identifier><identifier>EISSN: 1432-2323</identifier><identifier>DOI: 10.1007/s00268-015-2981-0</identifier><identifier>PMID: 25651959</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Abdominal Surgery ; Aged ; Cardiac Surgery ; Delayed Gastric Emptying ; Esophagitis - etiology ; Female ; Fundoplication ; Gastrectomy - methods ; Gastroesophageal Reflux - complications ; Gastroesophageal Reflux - surgery ; Gastroparesis - complications ; Gastroparesis - surgery ; Gastroscopy ; General Surgery ; Hernia, Hiatal - surgery ; Herniorrhaphy ; Hiatus Hernia ; Hiatus Hernia Repair ; Humans ; Innovative Surgical Techniques Around the World ; Medicine ; Medicine &amp; Public Health ; Middle Aged ; Quality of Life ; Short Gastric Vessel ; Sleeve Gastrectomy ; Surgery ; Thoracic Surgery ; Treatment Outcome ; Vascular Surgery</subject><ispartof>World journal of surgery, 2015-06, Vol.39 (6), p.1460-1464</ispartof><rights>Société Internationale de Chirurgie 2015</rights><rights>2015 The Author(s) under exclusive licence to Société Internationale de Chirurgie</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4221-ee5a018b1e97a416d445cc372ab71f91ba4d829e08df87628803461fbba82a523</citedby><cites>FETCH-LOGICAL-c4221-ee5a018b1e97a416d445cc372ab71f91ba4d829e08df87628803461fbba82a523</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25651959$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Le Page, Philip A.</creatorcontrib><creatorcontrib>Martin, David</creatorcontrib><title>Laparoscopic Partial Sleeve Gastrectomy with Fundoplication for Gastroesophageal Reflux and Delayed Gastric Emptying</title><title>World journal of surgery</title><addtitle>World J Surg</addtitle><addtitle>World J Surg</addtitle><description>Background A difficult management problem for the upper gastrointestinal surgeon exists when a patient presents with symptomatic and refractory severe delayed gastric emptying. Surgical treatment is further complicated by coexisting gastro-oesophageal reflux. No universal surgical strategy exists for this problem. Methods A novel surgical strategy combines partial sleeve gastrectomy (SG) and hiatus hernia (HH) repair with fundoplication. A review of treating four such patients is described with objective outcome data. Results Overall, solid gastric emptying improved in all, from median 350 (163–488) min pre-operatively to 108 (84–135) at 10 months (3–24) post-operatively, corresponding to 67 % improvement. Primary symptoms resolved in all; however, one patient had recurrent symptoms. GERD-HRQL also improved in all, from median 23 (3–25) to 4 (0–8) at 21 months (6–30, 83 % improvement). Gas bloat improved in three. All had post-operative gastroscopies showing intact repair and absent oesophagitis, with no patient requiring post-operative PPI. Patient weight reduced by median 11 % (7–20) post-operatively. There was no significant peri-operative morbidity. 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Public Health</subject><subject>Middle Aged</subject><subject>Quality of Life</subject><subject>Short Gastric Vessel</subject><subject>Sleeve Gastrectomy</subject><subject>Surgery</subject><subject>Thoracic Surgery</subject><subject>Treatment Outcome</subject><subject>Vascular Surgery</subject><issn>0364-2313</issn><issn>1432-2323</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><recordid>eNqFkcFu1TAQRS1ERV8LH8AGRWLDJnTGTmJ7CaWvUD0JREEsLSeZvKZK4tROKPn7ukpBqBJi5Vmcc3Xly9hLhLcIIE8CAC9UCpinXCtM4QnbYCZ4ygUXT9kGRJHFG8UhOwrhGgBlAcUzdsjzIked6w2bdna03oXKjW2VfLF-am2XXHZEPyk5t2HyVE2uX5LbdrpKtvNQu7FrKzu1bkga51fGUXDjld1TdL9S082_EjvUyQfq7EL1ysT4s36clnbYP2cHje0CvXh4j9n37dm304_p7vP5p9N3u7TKOMeUKLeAqkTS0mZY1FmWV5WQ3JYSG42lzWrFNYGqGyULrhSIrMCmLK3iNufimL1Zc0fvbmYKk-nbUFHX2YHcHAwWClALABHR14_Qazf7IbaLlNQRQ6kihStVxS8Lnhoz-ra3fjEI5n4Ss05i4iTmfhID0Xn1kDyXPdV_jN8bRECvwG3b0fL_RPPj4vL9FqSQGF2-uiFqw578X7X_2egOci6oBg</recordid><startdate>201506</startdate><enddate>201506</enddate><creator>Le Page, Philip A.</creator><creator>Martin, David</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>201506</creationdate><title>Laparoscopic Partial Sleeve Gastrectomy with Fundoplication for Gastroesophageal Reflux and Delayed Gastric Emptying</title><author>Le Page, Philip A. ; Martin, David</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4221-ee5a018b1e97a416d445cc372ab71f91ba4d829e08df87628803461fbba82a523</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Abdominal Surgery</topic><topic>Aged</topic><topic>Cardiac Surgery</topic><topic>Delayed Gastric Emptying</topic><topic>Esophagitis - etiology</topic><topic>Female</topic><topic>Fundoplication</topic><topic>Gastrectomy - methods</topic><topic>Gastroesophageal Reflux - complications</topic><topic>Gastroesophageal Reflux - surgery</topic><topic>Gastroparesis - complications</topic><topic>Gastroparesis - surgery</topic><topic>Gastroscopy</topic><topic>General Surgery</topic><topic>Hernia, Hiatal - surgery</topic><topic>Herniorrhaphy</topic><topic>Hiatus Hernia</topic><topic>Hiatus Hernia Repair</topic><topic>Humans</topic><topic>Innovative Surgical Techniques Around the World</topic><topic>Medicine</topic><topic>Medicine &amp; Public Health</topic><topic>Middle Aged</topic><topic>Quality of Life</topic><topic>Short Gastric Vessel</topic><topic>Sleeve Gastrectomy</topic><topic>Surgery</topic><topic>Thoracic Surgery</topic><topic>Treatment Outcome</topic><topic>Vascular Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Le Page, Philip A.</creatorcontrib><creatorcontrib>Martin, David</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Immunology Abstracts</collection><collection>Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health &amp; 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Surgical treatment is further complicated by coexisting gastro-oesophageal reflux. No universal surgical strategy exists for this problem. Methods A novel surgical strategy combines partial sleeve gastrectomy (SG) and hiatus hernia (HH) repair with fundoplication. A review of treating four such patients is described with objective outcome data. Results Overall, solid gastric emptying improved in all, from median 350 (163–488) min pre-operatively to 108 (84–135) at 10 months (3–24) post-operatively, corresponding to 67 % improvement. Primary symptoms resolved in all; however, one patient had recurrent symptoms. GERD-HRQL also improved in all, from median 23 (3–25) to 4 (0–8) at 21 months (6–30, 83 % improvement). Gas bloat improved in three. All had post-operative gastroscopies showing intact repair and absent oesophagitis, with no patient requiring post-operative PPI. Patient weight reduced by median 11 % (7–20) post-operatively. There was no significant peri-operative morbidity. Conclusions With careful patient selection and work-up, SG and HH repair with fundoplication may improve quality of life by coupling adequate reflux control with improved gastric emptying.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>25651959</pmid><doi>10.1007/s00268-015-2981-0</doi><tpages>5</tpages></addata></record>
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subjects Abdominal Surgery
Aged
Cardiac Surgery
Delayed Gastric Emptying
Esophagitis - etiology
Female
Fundoplication
Gastrectomy - methods
Gastroesophageal Reflux - complications
Gastroesophageal Reflux - surgery
Gastroparesis - complications
Gastroparesis - surgery
Gastroscopy
General Surgery
Hernia, Hiatal - surgery
Herniorrhaphy
Hiatus Hernia
Hiatus Hernia Repair
Humans
Innovative Surgical Techniques Around the World
Medicine
Medicine & Public Health
Middle Aged
Quality of Life
Short Gastric Vessel
Sleeve Gastrectomy
Surgery
Thoracic Surgery
Treatment Outcome
Vascular Surgery
title Laparoscopic Partial Sleeve Gastrectomy with Fundoplication for Gastroesophageal Reflux and Delayed Gastric Emptying
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