Failed Anti-Reflux Therapy: Analysis of Causes and Principles of Treatment

141 Pages·2017·5.05 MB·English

by  P. Marco Fisichella (eds.)

P. Marco Fisichella
Editor
Failed Anti-
Reflux Therapy
Analysis of Causes and
Principles of Treatment
123
Failed Anti-Reflux Therapy
P. Marco Fisichella
Editor
Failed Anti-Reflux
Therapy
Analysis of Causes and Principles
of Treatment
Editor
P. Marco Fisichella
Department of Surgery
VA Boston Healthcare System
Brigham and Women’s Hospital
Harvard Medical School
West Roxbury, MA
USA
ISBN 978-3-319-46884-6 ISBN 978-3-319-46885-3 (eBook)
DOI 10.1007/978-3-319-46885-3
Library of Congress Control Number: 2017932747
© Springer International Publishing AG 2017
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To Barbara Jericho
Preface
A fundoplication is very effective in controlling the symptoms of gastro-
esophageal reflux disease (GERD) in most patients. However, the procedure
proves ineffective in 10–15% of patients. In these patients, symptoms of
GERD recur or they experience dysphagia. Some of these patients eventually
need a second operation. However, the chances of success of a second opera-
tion are inferior to the outcome of primary surgery. Hence, the management
of patients who fail antireflux surgery is complex, and the indications for
reoperation are far from straightforward. This book will cover the compre-
hensive evaluation and treatment of failed antireflux therapy. Pathophysiology,
diagnostic evaluation, treatment, and strategies are included and based both
on evidence-based data and the experience of the contributors. Each chapter
will describe a very specific aspect of the analysis of causes and principles of
treatment for failed medical and surgical therapy, by a known expert. In addi-
tion, this book will outline the current diagnostic and management strategies
of failures, as well as the simplified re-operative approaches with relevant
technical considerations.
I thank all the contributors for their efforts, André Tournois for his help as
the editorial assistant, and Julia Megginson and Melissa Morton, from
Springer, for their continued and relentless support.
West Roxbury, MA, USA P. Marco Fisichella
vii
Contents
1 History of Medical and Surgical Antireflux Therapy . . . . . . . . . . 1
Fernando A.M. Herbella and Ana Cristina C. Amaral
2 Establishing the Diagnosis of GERD . . . . . . . . . . . . . . . . . . . . . . . 13
Wai-Kit Lo and Hiroshi Mashimo
3 Medical Management of GERD: Algorithms and Outcomes . . . 19
Wai-Kit Lo and Hiroshi Mashimo
4 Principles of Successful Surgical Antireflux Procedures . . . . . . 25
Rafael Melillo Laurino Neto and Fernando A.M. Herbella
5 Diagnosis and Treatment of the Extraesophageal
Manifestations of Gastroesophageal Reflux Disease . . . . . . . . . . 33
Feroze Sidwa, Alessandra Moore, Elaine Alligood, and P. Marco
Fisichella
6 Acute Complications of Antireflux Surgery . . . . . . . . . . . . . . . . . 51
Talar Tatarian, Michael J. Pucci, and Francesco Palazzo
7 Management of Complications: After Paraesophageal Hernia
Repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Nisha Dhanabalsamy, Melissa M. Carton, and Carlos Galvani
8 Persistent Symptoms After Antireflux Surgery and Their
Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Lawrence F. Borges and Walter W. Chan
9 Technical Surgical Failures: Presentation, Etiology,
and Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Chase Knickerbocker, Devendra Joshi, and Kfir Ben-David
10 Symptoms After Antireflux Surgery: Not Everything
Is Caused By Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Meredith C. Duke and Timothy M. Farrell
11 The Medical and Endoscopic Management of Failed Surgical
Anti-reflux Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Aparna Repaka and Hiroshi Mashimo
ix
x Contents
12 Reoperation for Failed Antireflux Surgery . . . . . . . . . . . . . . . . 111
Luigi Bonavina
13 Short Esophagus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Verónica Gorodner, Rudolf Buxhoeveden, Federico Moser, and
Santiago Horgan
14 Esophagectomy for Failed Anti- reflux Therapy: Indications,
Techniques, and Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Daniela Treitl, Robert Grossman, and Kfir Ben-David
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
1
History of Medical and Surgical
Antireflux Therapy
Fernando A.M. Herbella
and Ana Cristina C. Amaral
Introduction an exclusive surgical anatomy: (1) access routes
to the esophagus may be variable and multiple;
Those who cannot remember the past are con- (2) oncologic margins are elusive; and (3) organs
demned to repeat it.
need to be prepared in order to replace it [4].
The Life of Reason, Volume 1, 1905
Also, the esophagus has a distinctive physiology:
George Santayana (1863–1952), Spaniard/
American philosopher (1) it is a digestive organ without known absorp-
tive or endocrine functions; (2) it is bounded by
Initial and scarce attempts to operate the two sphincters; and (3) it exhibits a motility pat-
esophagus have been described since the sev- tern only at feed and different from other diges-
enteenth century, mostly due to traumatic injury tive segments. Moreover, esophageal diagnostic
[1]; however, the real history of esophageal tests such as esophageal function tests and even
surgery is relatively young compared to other esophagoscopy are recent achievements. All this
organs. According to Fogelman and Reinmiller lead to unsuccessful tries and fears to operate the
[2], esophageal surgery was both uncommon and esophagus and consequently delay in the devel-
poorly performed prior to the nineteenth century. opment of procedures even though esophageal
This may be attributed to the fact that the esopha- diseases have odd characteristics too: (1) they
gus is a peculiar organ. It has a unique anatomy: frequently affect other organs, either through
(1) important organs surround the esophagus in neoplastic dissemination or regurgitation of
its entire length; (2) the esophagus crosses the esophageal refluxed contents; (2) they mimic
neck, the chest, and the abdomen; (3) it lacks a diseases from other organs; and (3) they bring
serosa and its own artery, and (4) the lymphatic severe suffering, e.g., gastroesophageal reflux
drainage is abundant and erratic [3]. This leads to disease (GERD) burdens quality of life in levels
comparable to or greater than that observed in
other chronic conditions, such as diabetes, arthri-
F.A.M. Herbella, MD (*) tis or congestive heart failure [5].
Department of Surgery, Escola Paulista de Medicina, This book focuses on the failure of antireflux
Federal University of Sao Paulo, Sao Paulo, Brazil
therapy. The understanding that a collective and
Department of Surgery, Escola Paulista de Medicina, historical experience may help prevent the rep-
Rua Diogo de Faria 1087 cj 301, Sao Paulo, SP
etition of errors is essential. Although esopha-
04037-003, Brazil
geal surgery is still in the infancy, some lessons
e-mail: [email protected]
from the past are frequently ignored and those
A.C.C. Amaral, MD
who cannot remember the past are condemned to
Department of Medicine, Escola Paulista de Medicina,
Federal University of Sao Paulo, Sao Paulo, Brazil repeat it.
© Springer International Publishing AG 2017 1
P.M. Fisichella (ed.), Failed Anti-Reflux Therapy, DOI 10.1007/978-3-319-46885-3_1
2 F.A.M. Herbella and A.C.C. Amaral
Gastroesophageal Reflux Disease symptoms relieve after 20 years, with 49% of
radiologic recurrence of the hernia [12], a rate
The surgical history of GERD, or “ante-mortem below paraesophageal mesh-reinforced hiato-
digestion of the esophagus” [6] was associated plasty and fundoplication in modern series [13].
for a long time with esophagitis and hiatal hernia Latter, it was acknowledged that GERD could
(HH), since they were considered synonyms. exist without an associated HH and Allison
Esophagitis was firstly describe by Quincke procedure was also carried out successfully
in 1859 [7] (Fig. 1.1) but Winkelstein is usually in these patients [14]. From this time, became
given the credit for first describing peptic esoph- clear that fixing the HH and performing a hiato-
agitis as a new clinical entity only in 1935 [8]. plasty were essential parts of the surgical treat-
Postmortem description of diaphragmatic hernias ment for GERD. In fact, modern authors learned
can be found in Hippocrates works, but Morgagni that the absence of a hiatoplasty leads to much
in 1769 described HH as it is known nowadays worse outcomes [15]. This fact culminated
(Fig. 1.2). In the clinical scenario, Eppinger diag- with the use of prosthetic reinforcement of the
nosed the first HH in a live patient and Mayo did hiatus to make this part of the procedure even
the first operation for this condition in 1909 [9]. stronger, actually not a modern idea but dating
The initial therapy for GERD consisted
in replacing the stomach to the abdomen and
repairing and tightening the esophageal hiatus.
Philip Rowland Allison (1908–1974) (Fig. 1.3),
a British surgeon [10], initiated the modern era
of antireflux surgery. He published in 1951 [11]
a series of patients that, utilizing a transthoracic
approach, the stomach were reduced to the abdo-
men and the crural fibers were closed behind
the esophagus. He believed these crural fibers
functioned as a pinchcock to prevent reflux. He
had good long term results with over 80% of
Fig. 1.2 Joannes Baptista Morgagnus. First description
of a hiatal hernia (Source: National Library of Medicine
Images from the History of Medicine)
Fig. 1.1 Heinrich Quincke. First description of esophagi- Fig. 1.3 Philip Rowland Allison. Initiator of the modern
tis (Source: National Library of Medicine Images from antireflux surgery (Reproduced from Bani-Hani and Bani-
the History of Medicine) Hani [90] with permission)