Symptomatic and objective results of laparoscopic Nissen fundoplication after failed EndoCinch gastroplication for gastro-oesophageal reflux disease

Furnée EJ, Broeders JA, Draaisma WA, Schwartz MP, Hazebroek EJ, Smout AJ, Broeders IA.

BACKGROUND
Several endoscopic techniques have been introduced to treat gastro-oesophageal reflux disease, but their effectiveness varies. Subsequent laparoscopic Nissen fundoplication (LNF) might be required because of persistence or recurrence of symptoms. The aim of this study was to evaluate the outcome of LNF after previous EndoCinch gastroplication.

METHODS
Eleven consecutive patients who underwent LNF after failed EndoCinch were included. Data were prospectively collected. Symptomatic outcome was obtained by validated questionnaires, and objective outcome by endoscopy, oesophageal manometry and pH monitoring.

RESULTS
LNF was performed without major complications. After a median (range) follow-up of 31 (6-61) months, preoperative symptoms were resolved or improved in nine patients (81.8%), and general quality of life was significantly improved. None of the patients experienced daily complaints of heartburn postoperatively, and the median Gastro-Esophageal Reflux Disease Health Related Quality of Life score was 4 (0-9). Three patients (27.3%) had troublesome daily dysphagia. Oesophageal acid exposure was normalised after surgery in all but one patient, and another patient (9.1%) had persisting grade A oesophagitis. One patient (9.1%) underwent revisional LNF because of reflux and dysphagia caused by an intrathoracic migrated wrap.

CONCLUSION
This study has shown that quality of life and reflux control were satisfactory after LNF for failed EndoCinch gastroplication. Troublesome dysphagia was more frequently present after surgery in comparison with primary LNF.