(Incorporated in the Cayman Islands with limited liability) (the “Company”) (Stock Code: 3999) LETTER TO EXISTING REGISTERED SHAREHOLDERS – ELECTION OF LANGUAGE OF FUTURE CORPORATE COMMUNICATIONS We are pleased to enclose the 2008 Annual Report and the circular dated 22 April 2009 (the “Circular”) of the Company for your attention. The 2008 Annual Report and the Circular hav
Laparoscopic antireflux surgery for gastroesophageal reflux disease (gerd) results of a consensus development conferenceLaparoscopic antireflux surgery for gastroesophageal reflux
Results of a Consensus Development Conference
Held at the Fourth International Congress of the European Association for Endoscopic Surgery(E.A.E.S.), Trondheim, Norway, June 21–24, 1996 Conference Organizers: E. Eypasch,1 E. Neugebauer2 with the support of F. Fischer1 and H. Troidl1
for the Scientific and Educational Committee of the European Association for Endoscopic Surgery (E.A.E.S.)
Expert Panel: A. L. Blum, Division de Gastro-Ente´rologie, Centre Hospitalier, Universitaire Vaudois (CHUV)
Lausanne (Switzerland); D. Collet, Department of Surgery, University of Bordeaux, (France); A. Cuschieri, Department
of Surgery, Ninewells Hospital and Medical School, University of Dundee, Dundee, Scotland (U.K.); B. Dallemagne,
Department of Surgery, Saint Joseph Hospital, Lie`ge (Belgium); H. Feussner, Chirurgische Klinik u. Poliklinik rechts
der Isar, Universita¨t Mu¨nchen, Mu¨nchen (Germany); K.-H. Fuchs, Chirurgische Universita¨tsklinik und Poliklinik
Wu¨rzburg, Universita¨t Wu¨rzburg, Wu¨rzburg (Germany); H. Glise, Department of Surgery, Norra A
La¨nssjukhus, Trollha¨ttan (Sweden); C. K. Kum, Department of Surgery, National University Hospital, Singapore; T.
Lerut, Department of Thoracic Surgery, University Hospital Leuven, Leuven (Belgium); L. Lundell, Department of
Surgery, Sahlgren’s Hospital, University of Go¨teborg, Go¨teborg (Sweden); H. E. Myrvold, Department of Surgery,
Regionsykehuset, University of Trondheim, Trondheim (Norway); A. Peracchia, Department of Surgery, University of
Milan, School of Medicine, Milan (Italy); H. Petersen, Department of Medicine, Regionsykehuset, University of
Trondheim, Trondheim (Norway); J. J. B. van Lanschot, Academisch Ziekenhuis, Department of Surgery, University of
Amsterdam, Amsterdam (Netherlands) Representative of Prof. Dr. Tytgat (Netherlands)
1 Surgical Clinic Merheim, II Department of Surgery, University of Cologne, Ostermerheimer Str. 200, 51109 Cologne, Germany2 Biochemical and Experimental Division, II Department of Surgery, University of Cologne, Ostermerheimer Str. 200, 51109 Cologne, Germany Received: 29 November 1996/Accepted: 14 December 1996 Abstract
three phases: closed discussion in the expert group, public Background: Laparoscopic antireflux surgery is currently a discussion during the conference, and final closed discus- growing field in endoscopic surgery. The purpose of the Consensus Development Conference was to summarize the Results: Consensus statements were achieved on various state of the art of laparoscopic antireflux operations in June aspects of gastroesophageal reflux disease and current lap- aroscopic treatment with respect to indication for operation, Methods: Thirteen internationally known experts in gastro- technical details of laparoscopic procedures, failure of op- esophageal reflux disease were contacted by the conference erative treatment, and complete postoperative follow-up organization team and asked to participate in a Consensus evaluation. The strength of evidence in favor of laparoscop- Development Conference. Selection of the experts was ic antireflux procedures was based mainly on type II studies.
based on clinical expertise, academic activity, community A majority of the experts (6/10) concluded in an overall influence, and geographical location. According to the cri- assessment that laparoscopic antireflux procedures were teria for technology assessment, the experts had to weigh the current evidence on the basis of published results in the Conclusions: Further detailed studies in the future with literature. A preconsensus document was prepared and dis- careful outcome assessment are necessary to underline the tributed by the conference organization team. During the consensus that laparoscopic antireflux operations can be E.A.E.S. conference, a consensus document was prepared in Key words: Consensus development conferences — Lapa-
roscopic antireflux operations — Outcome assessment In the last 2 years, growing experience and enormous tech- and Troidl [190a]. Each panelist was asked to indicate what nical developments have made it possible for almost any level of development, in his opinion, laparoscopic antireflux abdominal operation to be performed via endoscopic sur- surgery has attained generally, and he was given a form gery. Laparoscopic cholecystectomy, appendectomy, and containing specific TA parameters relevant to the endo- hernia repair have been going through the characteristic life scopic procedure under assessment. In this form, the pan- cycle of technological innovations, and cholecystectomy, at elist was asked to indicate the status of the endoscopic pro- least, seems to have proven a definitive success. To evaluate cedure in comparison with conventional open procedures this life cycle, consensus conferences on these topics have and also to make a comparison between surgical and medi- been organized and performed by the E.A.E.S. [76b].
cal treatment of gastroesophageal reflux disease. The pan- Currently, the interest of endoscopic abdominal surgery elist’s view must have been supported by evidence in the is focusing on antireflux operation. This is documented by literature, and a reference list was mandatory for each item.
an increasing number of operations and publications in the Each panelist was given a list of relevant specific questions literature. The international societies such as the European pertaining to each procedure (indication, technical aspects, Association for Endoscopic Surgery (E.A.E.S.) have the re- training, postoperative evaluation, etc.). The panelists were sponsibility to provide a forum for discussion of new de- asked to provide brief answers with references. Guidelines velopments and to provide guidelines on best practice based for response were given and the panelists were asked to on the current state of knowledge. Therefore, a consensus send their initial evaluation back to the conference organiz- development conference on laparoscopic antireflux surgery ers 3 months prior to the conference.
for gastroesophageal reflux disease (GERD) was held, In Cologne, the congress organization team analyzed the which included discussion of some pathophysiological as- individual answers and compiled a preconsensus provi- pects of the disease. Based on the experience of previous consensus conferences (Madrid 1994), the process of the In particular, the input and comments of gastroenterolo- consensus development conference was slightly modified.
gists were incorporated to modify the preconsensus docu- The development process was concentrated on one sub- ject—reflux disease—and during the 4th International The preconsensus documents were posted to each pan- Meeting of the E.A.E.S., a long public discussion, including elist prior to the Trondheim meeting. During the Trondheim all aspects of the consensus document, was incorporated conference, in a 3-h session, the preconsensus document was scrutinized word by word and a version to be presented The methods and the results of this consensus confer- in the public session was prepared. The following day, a 2-h ence are presented in this comprehensive article.
public session took place, during which the text and thetables of the consensus document were read and discussedin great detail. A further 2-h postconference session of the panelists incorporated all suggestions made during the pub-lic session. The final postconsensus document was mailed At the Annual Meeting in Luxemburg in 1995, the joint to all expert participants, checked for mistakes and neces- session of the Scientific and Educational Committee of the sary corrections and finalized in September 1996. The full E.A.E.S. decided to hold a Consensus Development Con- text of the statements is given below.
ference (CDC) on laparoscopic antireflux surgery for gas-troesophageal reflux disease. The 4th International Con-gress of the E.A.E.S. in June 1996 in Trondheim should be Consensus Statements on Gastroesophageal Reflux
the forum for the public discussion and finalization of the Disease (GERD)
The Cologne group (E. Neugebauer, E. Eypasch, F.
Fischer, H. Troidl) was authorized to organize the CDC 1. What are the epidemiologic facts in GERD? according to general guidelines. The procedure chosen wasthe following: A small group of 13 internationally known In western countries, gastroesophageal reflux has a high experts was nominated by the Scientific Committee of the prevalence. In the United States and Europe, up to 44% of the adult population describe symptoms characteristic of 1. Clinical expertise in the field of endoscopic surgery GERD [124, 127, 242]. Troublesome symptoms character- istic of GERD occur in 10–15% with equal frequency in men and women. Men, however, seem to develop reflux esophagitis and complications of esophagitis more fre-quently than women .
Internationally well-known gastroenterologists were asked Data from the literature indicate that 10–50% of these to participate in the conference in the interest of a balanced subjects will need long-term treatment of some kind for discussion between internists and surgeons.
their symptoms and/or esophagitis [34, 195, 225, 242].
Prior to the conference, each panelist received a docu- The panelists agreed that the natural history of the dis- ment containing guidelines on how to estimate the strength ease varies widely from very benign and harmless reflux to of evidence in the literature for specific endoscopical pro- a disabling stage of the disease with severe symptoms and cedures and a document containing descriptions of the lev- morphological alterations. There are no good long-term data els of technology assessment (TA) according to Mosteller indicating how the natural history of the disease changes from one stage to the other and when and how complica- GERD is frequently classified as a synonym for esoph- tions (esophagitis, stricture, etc.) develop.
agitis, even though there is considerable evidence that only Topics which were the subject of considerable debate 60% of patients with reflux disease sustain damage of their but which could not be resolved during this conference are mucosa [8, 91, 150, 200, 231, 243]. The MUSE and Savary esophagitis classifications are currently used to stage dam-age, but they are poor for staging the disease .
● The cause of the increasing prevalence of esophagitis The modified AFP Score (Anatomy-Function- ● The cause of the increasing prevalence of Barrett’s Pathology) is an attempt to incorporate the presence of hia- tus hernia, reflux, and macroscopic and morphologic dam- ● The discrepancy between clinically and anatomically de- age into a classification . However, this classification termined prevalence of Barrett’s esophagus lacks symptomatology and should be linked to a scoring ● The problem of ultrashort Barrett’s esophagus and its system for symptoms or quality of life; both scoring systems are extremely important for staging of the disease and for ● The relationship between Helicobacter pylori infection the indication for treatment [195a,b].
● Gastroesophageal reflux without esophagitis and abnor- ● The role of so-called alkaline reflux, which is currently 4. What establishes the diagnosis of the disease? A large variety of different symptoms are described in thecontext of gastroesophageal reflux disease, such as dyspha- 2. What is the current pathophysiological concept gia, pharyngeal pain, hoarseness, nausea, belching, epigas- tric pain, retrosternal pain, acid and food regurgitation, GERD is a multifactorial process in which esophageal and retrosternal burning, heartburn, retrosternal pressure, and gastric changes are involved [27, 65, 98, 251, 283].
coughing. The characteristic symptoms are heartburn Major causes involved in the pathophysiology are in- (retrosternal burning), regurgitation, pain, and respiratory competence of the lower esophageal sphincter expressed as symptoms [150, 204]. Symptoms are usually related to pos- low sphincter length and pressure, frequent transient lower esophageal sphincter relaxations, insufficient esophageal In addition, typical reflux patients may have symptoms peristalsis, altered esophageal mucosal resistance, delayed which are not located in the region of the esophagus. Pa- gastric emptying, and antroduodenal motility disorders with tients with heartburn may or may not have pathological pathologic duodenogastroesophageal reflux [27, 65, 92, 95, reflux. They may have reflux-type ‘‘nonulcer dyspepsia’’ or Several factors can play an aggravating role: stress, pos- The diagnostic tests that are needed must follow a cer- ture, obesity, pregnancy, dietary factors (e.g., fat, chocolate, tain algorithm. After the history and physical examination caffeine, fruit juice, peppermint, alcohol, spicy food), and of the patients, an upper gastrointestinal endoscopy is per- drugs (e.g., calcium antagonists, anticholinergics, theophyl- formed. A biopsy is taken if any abnormalities (stenosis, line, ␤-blockers, dihydropyridine). All these factors might strictures, Barrett’s, etc.) are found .
influence the pressure gradient from the abdomen to the If no morphologic evidence can be detected, only func- chest either by decreasing the lower esophageal sphincter or tional studies, e.g., measuring the acid exposure in the esophageal lumen by 24-h esophageal pH monitoring, are Other parts of the physiological mosaic that might con- helpful and indicated to detect excessive reflux . It is of tribute to gastroesophageal reflux include the circadian vital importance that the pH electrode be accurately posi- rhythm of sphincter pressure, gastric and salivary secretion, tioned in relation to the lower esophageal sphincter (LES).
esophageal clearance mechanisms, as well as hiatal hernia Manometry is the only objective way to assess the location and Helicobacter pylori infection.
Ordinary esophageal radiologic studies (barium swal- low) are considered another mandatory basic imaging study 3. What is a useful definition of the disease? At the next level of investigation there are a number of A universally agreed upon scientific classification of GERD tests that look for the cause of pathologic reflux using is not yet available. The current model of gastroesophageal esophageal manometry as a basic investigative tool for this reflux disease sees it as an excessive exposure of the mu- purpose to assess lower esophageal sphincter and esopha- cosa to gastric contents (amount and composition) causing geal body function [27, 65, 91, 134, 283]. Video esopha- symptoms accompanied and/or caused by different patho- gography or esophageal emptying scintigraphy may also be physiological phenomena (sphincter pressure, peristalsis) leading to morphological changes (esophagitis, cell infiltra- Optional gastric function studies are 24-h gastric pH monitoring, photo-optic bilirubin assessment to assess duo- This implies an abnormal exposure to acid and/or other denogastroesophageal reflux, gastric emptying scintigraphy, gastric contents like bile and duodenal and pancreatic juice and antroduodenal manometry [81, 93, 95, 118, 146, 234].
in cases of a combined duodenogastroesophageal reflux.
Currently these gastric function studies are of scientific Table 1. Diagnostic test ranking order for GERD
Savary-Miller classification I, II, II, IV, V (M) metaplasia(U) ulcer(S) stricture(E) erosions Percentage time below pH 4 DeMeester score Overall lengthIntraabdominal lengthPressure (Transient LES relaxations) esophageal body a The concise numerical values for sphincter length, pressure, and relaxation depend on the respective manometric recording system used in the esophageal-function lab interest but they do not yet play a role in overall clinical Therefore the indication for surgery is based on the fol- patient management, apart from selected patients. The di- agnostic test ranking order is displayed in Table 1.
● Noncompliance of the patient with ongoing effective medical treatment. Reasons for noncompliance are pref- 5. What is the indication for treatment? erence, refusal, reduced quality of life, or drug depen- Pivotal criteria for the indication to medical treatment in gastroesophageal reflux disease are the patient’s symptoms, ● Persistent or recurrent esophagitis in spite of currently reduced quality of life, and the general condition of the optimal medical treatment and in association with symp- patient. When symptoms persist or recur after medication, ● Complications of the disease (stenoses, ulcers, and Bar- Mucosal damage (esophagitis) indicates a strong need rett’s esophagus [11, 68]) have a minor influence on the for medical treatment. If the symptoms persist, partially indication. Neither medical nor surgical treatment has persist, or recur after stopping medication, there is a good been shown to alter the extent of Barrett’s epithelium.
indication for doing functional studies. Gastrointestinal en- Therefore mainly symptoms and their relation to ongoing doscopy, already mentioned as the basic imaging examina- medical treatment play the major role in the indication for tion in GERD, should be performed in context with the surgery. However, antireflux surgery may reduce the need for subsequent endoscopic dilatations [21a]. The Indication for surgery is again centrally based on the participants pointed out that patients with symptoms com- patient’s symptoms, the duration of the symptoms, and the pletely resistant to antisecretory treatment with H - blockers or proton-pump inhibitors are bad candidates for Even after successful medical acid suppression the pa- surgery. In these individuals other diseases have to be tient can have persistent or recurrent symptoms of epigastric investigated carefully. On the contrary, good candidates pain and retrosternal pressure as well as food regurgitation for surgery should have a good response to antisecretory due to the incompetent cardia, insufficient peristalsis, and/or drugs. Thus, compliance and preference determine which treatment is chosen (conservative or operative).
With respect to indication, one important factor in the patient’s general condition is age. On the one hand, age 6. What are the essentials of laparoscopic surgical plays a role in the risks stratification when the individual risk of an operation is estimated together with the comor-bidity of the patient. On the other hand, age is an economic The goal of surgical treatment for GERD is to relieve the factor with respect to the break-even point between medical symptoms and prevent progression and complications of the disease creating a new anatomical high-pressure zone. This Concerning the indication for surgery, a differentiation must be achieved without dysphagia, which can occur when in the symptoms between heartburn and regurgitation is the outflow resistance of the reconstructed GE junction ex- considered important. (Medical treatment appears to be ceeds the peristaltic power of the body of the esophagus.
more effective for heartburn than for regurgitation.) Achievement of this goal requires an understanding of the natural history of GERD, the status of the patient’s esoph- Instruments: The examples of instruments are listed in ageal function, and a selection of the appropriate antireflux The earliest point at which one ought to collect func- Since the newly created structure is only a substitute for tional data after the operation is 6 months. The reasonable the lower esophageal sphincter, it is a matter of discussion time of assessment in the postsurgical follow-up phase is to what extent it can show physiological reactions (normal probably 1 year followed by 2-year intervals.
resting pressure, reaction to pharmacological stimuli, appro- Economic assessment is considered to be a significant priate relaxations during deglutition, etc.). There is no endpoint and is dealt with in a later section.
agreement on how surgical procedures work and restore the There is no evidence that laparoscopic surgery should be any better than conventional surgery. If laparoscopic sur- With respect to the details of the laparoscopic surgical gery is correctly performed, apart from the problems of procedures, the following degree of consensus was attained abdominal wall complications like hernia, infection, and by the panel (11 present participants) (yes/no): wound rupture, there should be no difference in outcome ascompared to the standard obtained in open surgery.
1. Is there a need for mobilization of the gastric fundus by Laparoscopic surgery, however, has the potential to re- dividing the short gastric vessels? (7/4) duce postoperative pain and limitations of daily activity.
2. Is there a need for dissection of the crura? (11/0)3. Is there a need for identification of the vagal trunks? In gastroesophageal reflux disease, lifelong medication is 4. Is there a need for removal of the esophageal fat pad? needed in many patients, because the disease persists but the acid reduction can take away the symptoms during the time 5. Is there a need for closure of the crura posteriorly? the medication is taken. The disease is treated by reducing the acid and not by treating or correcting the causes of the 6. Should nonabsorbable sutures be used (crura, wrap)? disease. This latter argument can be used by surgeons, since they mechanically restore the sphincter area and, therefore, 7. Should a large bougie (40–60 French) be used for cali- correct the most frequent defect associated with the disease.
In surgery, failure of a treatment is defined as the per- 8. Should objective assessment be performed (e.g., cali- sistence or recurrence of symptoms and/or objective patho- logic findings once the treatment phase is finished. In GERD, a definite failure is present when symptoms which are severe enough to require at least intermittent therapy 9. If there is normal peristalsis should one (heartburn, regurgitation) recur after treatment or when Routinely use a 360° short floppy fundoplication other serious problems (‘‘slipped Nissen,’’ severe gas bloat syndrome, dumping syndrome, etc.) arise and when func- Routinely use a partial fundoplication wrap? (2) tional studies document that symptoms are due to this prob- Use a short wrap equal to or shorter than 2.5 cm? (1) lem. Recurrence can occur with or without esophageal dam- 10. In cases of weak peristalsis, should there be a ‘‘tailored age (esophagitis). Professor Blum (Lausanne) suggested approach’’ (total or partial wrap)? (5/6)1 that further long-term outcome studies of medical and sur-gical treatment are needed.
7. Which are the important endpoints of treatment Quality-of-life measurements are able to differentiate whether and to what extent recurrent symptoms are reallyimpairing the patient’s quality of life.
The important endpoints for the success of conservative/ It was agreed upon that a distinction is necessary be- medical as well as surgical therapy must be a mosaic of tween the two types of failures of the operation: ‘‘the un- different criteria, since neither clinical symptoms, func- happy 5–10%’’ (i.e. slipped Nissen, etc.) and the 10–40% of tional criteria, nor the daily activity and quality-of-life as- individuals who only become aware of their dyspeptic sessment can be used solely to assess the therapeutic result symptoms postoperatively while the reflux-related symp- in this multifactorial disease process.
toms are treated. Dyspeptic symptoms occur in the normal Patients show great variety in demonstrating and ex- pressing the severity of clinical symptoms and, therefore, Some of the ‘‘postfundoplication symptoms’’ are pre- they alone are not a reliable guide. Functional criteria can be sent already before the operation and are due to the dyspep- assessed objectively, but may not be used in the decision- tic symptomatology associated with GERD.
making process without looking at the stage of mucosal Patients with failures should be worked up with the damage or morphological abnormalities (hiatus hernia, available diagnostic tests to detect the underlying cause of the failure. If there is mild recurrent reflux, it usually can be Complete evaluation includes assessment of symp-
treated by medication as long as the patient is satisfied with toms, daily activity, and quality of life—ideally, in every
this solution and his/her quality of life is good. In the case single patient.
of severe symptomatic recurrent reflux or other complica-tions, and if endoscopy shows visible esophagitis, the indi- cation for refundoplication after a thorough diagnostic During the public discussion, Professor Montori (Rome) mentioned the Angelchick prosthesis as a rare alternative—however, this was not dis- workup must be established. Surgeons very experienced in pathophysiology, diagnosis, and the surgical technique of Table 2a. Ratings of published literature on antireflux operations and medical treatment: strength of evidence in the literature-antireflux operations
Clinical randomized controlled studies with power and 32, 37, 49, 80, 87, 110, 130, 147, 163, 188, 217, 221, Case-control studiesCohort studies with literature controls 3, 4, 12, 19, 22, 36, 44, 47, 49, 55, 60, 61, 63, 72, 73, 95, 89, 107, 113, 126, 132, 159, 162, 163, 177, 184, 187, 190, 192, 208, 212, 213, 216, 219, 237, 255,267 Table 2b. Ratings of published literature on antireflux operations and medical treatment: strength of evidence in the literature-medical treatment
Clinical randomized controlled studies with power and 10, 17, 24, 26, 39, 56, 70, 112, 115, 116, 120, 121, 139, 151, 161, 168, 171, 180, 189, 202, 223, 224, 227,228, 240, 244, 246, 263, 265, 268, 270, 274, 282,284 Case-control studiesCohort studies with literature controls 16, 23, 50, 72, 117, 123, 135, 152, 157, 172, 174, 200, Reports of expert committeesCase series without controls the disease should perform these redo operations. Expert 11. Perspective of the analysis (patient, hospital, society) management of patients undergoing redo surgery for a be- 12. Health care system (socialized, private) nign condition is of extreme importance.
A special issue is the so-called break-even point betweenmedical and surgical treatment (duration and cost of medi-cal treatment vs laparoscopic antireflux treatment) [21b].
9. What are the issues in an economic evaluation? Ultimately, the results of medical or surgical treatment, especially with respect to age of the patient, should be trans- With respect to a complete economic evaluation the panel- lated into quality-adjusted life-years (QALYs) to differen- ists refer to the available literature [14a, 76a].
tiate which treatment is better for what age, comorbidity, Cost, cost minimization, and cost-effectiveness analyses of gastroesophageal reflux disease must take into accountthe following issues (list incomplete): Literature list with ratings of references
All literature submitted by the panelists as supportive evi- dence for their evaluation was compiled and rated. The ratings of the references are based on the panelists’ evalu- ation. The number of references is incomplete for the case 5. Frequency of restricted family or hobby activity at series without controls and anecdotal reports. The result of the panelists’ evaluation is given in Table 2a for the endo- 6. Assessment of job performance and restrictions due to scopic antireflux operations and in Table 2b for medical treatments (all options). The consensus statements are based 7. Costs of diagnostic workup including functional studies on these published results. A complete list of all references mentioned in Table 2a and 2b is included.
8. Costs of surgical intervention9. Costs for treatment of surgical complications 10. Costs of treatment of complications of maintenance Question 1. What stage of technological development
medical therapy, such as emergency hospital admis- are endoscopic antireflux operations at (in June 1996)?
sions, e.g., swallowing discomfort, bolus entrapment in The definitions for the stages in technological development follow the recommendations of the Committee for Evaluat- Table 3. Evaluation of the status of endoscopic antireflux surgery 1996: level attained and strength of evidence
1. FeasibilityTechnical performance, applicability, safety, complications, morbidity, mortality ● Benefit for the patient demonstrated in centers of excellence ● Benefit for the surgeon (shorter operating time, easier technique) 3. EffectivenessBenefit for the patient under normal clinical conditions, i.e., good results 4. CostsBenefit in terms of cost-effectiveness long operation times, frequency of thrombo-embolization, incidence of reoperations, altered indication for surgery, etc.c a Mosteller F (1985) Assessing Medical Technologies, National Academy Press, Washington, DC [190a]: and Troidl H (1995) Endoscopic Surgery—aFascinating Idea Requires Responsibility in Evaluation and Handling. Minimal Access Surgery, Surgical Technology International III (1995) pp 111–117[265a].
b Level attained to the definitions of the different grades.
c Percentage of consensus was calculated by dividing the number of panelists who voted 0, I, II or III by total number of panelists who submitted theirevaluation forms.
Table 4a. Antireflux surgery vs open conventional procedures: evaluation of feasibility parameters by all panelists at CDC in Trondheim*
Assessment based on evidence in the literature FeasibilitySafety/intraop. adverse events—Gastric or esophageal leaks/ Table 4b. Antireflux surgery vs open conventional procedures: evaluation of efficacy parameters by all panelists prior to CDC in Trondheim
Assessment based on evidence in the literature a Comparison: laparoscopic fundoplication techniques vs open conventional procedure.
b Percentage of consensus was calculated by dividing the number of panelists who voted better (probably and definitely), similar, or worse (probably anddefinitely) by the total number of panelists who submitted their evaluation forms.
c Refer to Table 1.
ing Medical Technologies in Clinical Use (190a) (Mosteller antireflux surgery should be recommended in centers with- F., 1985) extended by criteria introduced by Troidl (1995).
sufficient experience and an adequate number of individuals The panel’s evaluation as to the attainment of each techno- with the disease. Randomized controlled studies are recom- logical stage by endoscopic antireflux surgery, together mended to compare medical vs laparoscopic surgical treat- with the strength of evidence in the literature, is presented in ment and partial vs total fundoplication wraps.
Technical performance and applicability were demon- strated by several authors as early as 1992/1993. The results Question 2. What is the current status of laparoscopic
on safety, complications, morbidity, and mortality data de- antireflux surgery vs open conventional procedures in
pend on the learning phase (>50 cases) of the operations.
terms of feasibility and efficacy parameters?
The complication, reoperation, and conversion rates arehigher in the first 20 cases of an individual surgeon. It is A table with specific parameters relevant to open and lap- strongly advocated that experienced supervision be sought aroscopic antireflux procedures summarizes the current sta- by surgeons beginning laparoscopic fundoplication during tus (Table 4). The evaluation is mainly based on type I and their first 20 procedures [278,a,b]. Data on efficacy (benefit type II studies (see list of references).
for the patient) demonstrated in centers of excellence were The results show that safety is comparable and rather based on type II studies. The benefit for the surgeon in terms favorable compared to the open technique. The incidence of elegance, ease, and speed of the procedure is not yet clear for complications, morbidity, and mortality is similar to the cut. The operation time is the same or longer, and the tech- open technique once the learning phase has been surpassed.
nique is harder initially—however, the view of the operat- For specific intraoperative and postoperative adverse events ing field is better. The effectiveness data are still insuffi- cient, long-term results are missing, and the results reported In terms of efficacy, significant advantages of the endo- come mainly from interested centers and multicenter stud- scopic antireflux operations are: less postoperative pain, ies. It is important to audit continually the results of anti- shorter hospital stay, and earlier return to normal activities reflux operations, especially because different techniques are used. The economic evaluation of laparoscopic antire- In general, laparoscopic antireflux surgery has advan- flux surgery is still premature (few data from small studies tages over open conventional procedures if performed by only). Future studies are recommended in different health care systems, assessing the relative economic advantages of Laparoscopic antireflux surgery has the potential to im- laparoscopic antireflux surgery in comparison to the avail- prove reflux treatment provided that appropriate diagnostic facilities for functional esophageal studies and adequately A major issue of ethical concern is the altered indication trained and dedicated surgeons are available.
for surgery. A change of indication might produce more costand harm in inappropriately selected patients. Laparoscopic Acknowledgments. The organizers would like to thank the panelists of the conference for their tremendous work and input in reaching these consen- gastroesophageal reflux: laparoscopic placement of the Angelchik sus statements. We appreciate very much the time and energy spent to prosthesis in pigs. Surg Endosc 5: 123–126 21a. Bonavina L, Bardini R, Baessato M, Peracchia A (1993) Surgical The organization of the conference was only possible with the generous treatment of reflux stricture of the esophagus. Br J Surg 80: 317 support of Professor Myrvold (Trondheim), the excellent assistance of Mrs 21b. Boom VDG, Go PMMYH, Hameeteman W, Dallemagne B (1996) Karin Nasskau (Cologne) and Dr. Rolf Lefering (Cologne) who strongly Costeffectiveness of medical versus surgical treatment in patients supported the conference evaluations.
with severe or refractory gastroesophageal reflux in the Netherlands.
Thanks also to the E.A.E.S. for their financial support and to Professor Myrvold, the President of the 4th International Conference of the E.A.E.S.
22. Bittner HB, Meyers WC, Brazer SR, Pappas TN (1944) Laparoscopic for enabling and supporting the conference.
Nissen fundoplication: operative results and short-term follow-up.
Am J Surg 167: 193–200 23. Blum AL (1990) Treatment of acid-related disorders with gastric acid References
inhibitors: the state of the art. Digestion 47: 3–10 24. Blum AL (1990) Cisapride prevents the relapse of reflux esophagitis.
Literature not mentioned in the statements but discussed during the con- ference is also cited in this list of references.
25. Blum AL, The EUROCIS-trialists (1990) Cisapride reduces the re- lapse rate on reflux esophagitis. World Congress of Gastroenterol- 1. Ackermann C, Margreth L, Mu¨ller C, Harder F (1988) Das Lang- zeitresultat nach Fundoplicatio. Schweiz Med Wochenschr 118: 774 26. Blum AL, Adami B, Bouzo MH (1991) Effect of cisapride on relapse 2. Allison PR (1951) Reflux oesophagitis, sliding hernia and the anato- of esophagitis. A multinational placebo-controlled trial in patients mie of repair. Surg Gynecol Obstet 92: 419–431 healed with an antisecretory drug. Dig Dis Sci 38: 551–560 3. Anvari N, Allen C (1996) Incidence of dysphagia following laparo- 27. Bonavina L, Evander A, DeMeester TR, Walther B, Cheng SC, Pa- scopic Nissen fundoplication without division of short gastrics. Surg lazzo L, Concannon JL (1986) Length of the distal esophageal sphincter and competency of the cardia. Am J Surg 151: 25–34 4. Anvari M, Allen C, Born A (1995) Laparoscopic Nissen fundoplica- 28. Brossard E, Monnier PH, Olhyo JB (1991) Serious complications— tion is a satisfactory alternative to long-term omeprazole therapy. Br stenosis, ulcer and Barrett’s epithelium—develop in 21.6% of adults with erosive reflux esophagitis. Gastroenterology 100: A36 5. Apelgren K (1996) Hospital charges for Nissen fundoplication and 29. Brunner G, Creutzfeldt W (1989) Omeprazole in the long-term man- other laparoscopic procedures. Surg Endosc 10: 359–360 agement of patients with acid-related diseases resistant to ranitidine.
6. Armstrong D, Blum AL (1989) Full-dose H2-receptor antagonist pro- phylaxis does not prevent relapse of reflux oesophagitis. Gut 30: 30. Cadiere GB, Houben JJ, Bruyns J, Himpens J, Panzer JM, Gelin M (1994) Laparoscopic Nissen fundoplication: technique and prelimi- 7. Armstrong D, Monnier P, Nicolet M, Blum AC, Savary M (1991) Endoscopic assessment of esophagitis. Gullet 1: 63–67 31. Cadiere GB, Himpens J, Bruyns J (1995) How to avoid esophageal 8. Armstrong D, Blum AL, Savary M (1992) Reflux disease and Bar- perforation while performing laparoscopic dissection of the hiatus.
9. Armstrong D, Nicolet M, Monnier P, Chapuis G, Savary M, Blum 32. Cadiere GB, Bruyns J, Himpens J, Vertuyen M (1996) Intrathoracic AL (1992) Maintenance therapy: is there still a place for antireflux migration of the wrap after laparoscopic Nissen fundoplication. Surg surgery? [Review]. World J Surg 16: 300–307 10. Arvanitakis C, Nikopoulos A, Theoharidis A (1993) Cisapride and 33. Castell DO (1985) Introduction to pathophysiology of gastroesopha- ranitidine in the treatment of gastro-oesophageal reflux disease—a geal reflux. In: Castell DO, Wu WC, Ott DJ (eds) Gastro- comparative randomized double-blind trial. Aliment Pharmacol Ther oesophageal reflux disease: pathogenesis, diagnosis, therapy. Future, 11. Attwood SEA, Barlow AP, Norris TL, Watson A (1992) Barrett’s 34. Castell DO (1994) Management of gastro-esophageal reflux disease oesophagus: effect of antireflux surgery on symptom control and 1995. Maintenance medical therapy of gastro-esophageal reflux— development of complications. Br J Surg 79: 1060–1063 which drugs and how long? Dis Esophagus 7: 230–233 12. Aye RW, Hill LD, Kraemer SJ, Snopkowski P (1994) Early results 35. Cederberg C, Andersson T, Skanberg I (1989) Omeprazole: pharma- with the laparoscopic Hill repair. Am J Surg 167: 542–546 cokinetics and metabolism in man. Scand J Gastroenterol 24: 33–40 13. Bagnato VJ (1992) Laparoscopic Nissen fundoplication. Surg Lapa- 36. Champault G (1994) Gastroesophageal reflux. Treatment by laparos- copy. 940 cases—French experience. Ann Chir 48: 159–164 14. Ball CS, Norris T, Watson A (1988) Acid sensitivity in reflux oe- 37. Champion JK, Mc Kernan JB (1995) Technical aspects for laparo- sophagitis with and without complications. Gut 29: 799 scopic Nissen fundoplication. Surg Technol Int IV: 103–106 14a. Barnes BA (1982) Cost benefit and cost effectiveness analysis in 38. Chiban N, Wilkinson J, Hurst RH (1943) Symptom relief in erosive surgery. Surg Clin North Am 62: 737–748 GERD, a meta-analysis. Am J Gastroenterol 88: 9 14b. Barlow AP, DeMeester TR, Boll CS, Eypasch EP (1989) The sig- 39. Chopra BK, Kazal HL, Mittal PK, Sibia SS (1992) A comparison of nificance of gastric hypersecretion in gastroesophageal reflux dis- the clinical efficacy of ranitidine and sucralfate in reflux oesophagi- tis. J Assoc Physicians India 40: 162–163 15. Bechi P, Pucciani F, Baldini F (1993) Long-term ambulatory entero- gastric reflux monitoring. Validation of a new fiber optic technique.
40. Clark GWB, Jamieson JR, Hinder RA, Polishuk PV, DeMeester TR, Gupta N, Cheng SC (1993) The relationship of gastric pH and the 16. Beck IT, Connon J, Lemire S, Thomson ABR (1992) Canadian con- emptying of solid, semisold and liquid meals. J Gastrointest Mot 5: sensus conference on the treatment of gastroesophageal reflux dis- 41. Cloud ML, Offen WW, Robinson M (1994) Nizatidine versus pla- 17. Behar J, Sheahan DG, Biancani B, Spiro HM, Storer EH (1975) cebo in gastro-oesophageal reflux disease: a 12-week, multicentre, Medical and surgical management of reflux esophagitis: a 38-month randomised, double-blind study. Br J Clin Pract 76: 3–10 report on a prospective clinical trial. N Engl J Med 293: 263–268 42. Cloyd DW (1994) Laparoscopic repair of incarcerated paraesopha- 18. Bell NJV, Burget B, Howden CW (1992) Appropriate acid suppres- sion for the management of gastro-oesophageal reflux disease. Di- 43. Coley CR, Bang MJ, Spechler SJ, Williford WO, Mulley AG (1993) Initial medical vs surgical therapy for complicated or chronic gas- 19. Bell RCW, Hanna P, Treibling A (1996) Experience with 1,202 lap- troesophageal reflux disease. A cost effectiveness analysis. Gastro- aroscopic Toupet fundoplications. Surg Endosc 10: 198 20. Belsey R (1977) Mark IV repair of hiatal hernia by the transthoracic 44. Collard JM, de Gheldere CA, De Kock M, Otte JB, Kestens PJ (1994) Laparoscopic antireflux surgery. What is real progress? Ann Surg 21. Berguer R, Stiegmann GV, Yamamoto M, Kim J, Mansour A, Den- ton J, Norton LW, Angelchik JP (1991) Minimal access surgery for 45. Collard JM, Romagnoli R, Kestens PJ (1996) Reoperation for unsat- isfactory outcome after laparoscopic antireflux surgery. Dis Esopha- DJ, Solcia E, Shearman DJC (1994) Omeprazole v ranitidine for prevention of relapse in reflux oesophagitia. A controlled double 46. Collen MJ, Strong RM (1992) Comparison of omeprazole and ran- blind trial of their efficacy and safety. Gut 35: 590–598 itidine in treatment of refractory gastroesophageal reflux disease in 71. DePaula AL, Hashiba K, Bafutto M, Machado CA (1995) Laparo- patients with gastric acid hypersecretion. Dig Dis Sci 37: 897–903 scopic reoperations after failed and complicated antireflux opera- 47. Collet D, Cadiere GB, the Formation for the Development of Lapa- roscopic Surgery for Gastroesophageal Reflux Disease Group (1995) 72. DeVault KR (1994) Current diagnosis and treatment of gastroesopha- Conversions and complications of laparoscopic treatment of gastro- geal reflux disease. Mayo Clin Proc 69: 867–876 esophageal reflux disease. Am J Surg 169: 622–626 73. Deveney K, Swanstrom L, Shepard B, Deneney C (1996) A state- 48. Congrave DP (1992) Brief clinical report. Laparoscopic paraesopha- wide registry for outcome of open and laparoscopic anti-reflux pro- geal hernia repair. J Laparoendosc Surg 2: 45–48 49. Coster DD, Bower WH, Wilson VT, Butler DA, Locker SC, Brebrick 74. Dimena¨s E (1993) Methodological aspect of evaluation of quality of RT (1995) Laparoscopic Nissen fundoplication: a curative, safe, and life in upper gastrointestinal diseases. Scand J Gastroenterol 28: 18– cost-effective procedure for complicated gastroesophageal reflux dis- 75. Donahue PE, Samelson S, Nyhus LM, Bombeck T (1985) The floppy 50. Creutzzfeldt W (1994) Risk-benefit assessment of omeprazole in the Nissen fundoplication. Effective long-term control of pathological treatment of gastrointestinal disorders. Drug Saf 10: 66–82 51. Crist DW, Gradaez TR (1993) Complications of laparoscopic sur- 76. Dor J, Humbert P, Dor V (1962) L’interet de la technique de Nissen modifie dans la prevention du reflux apres cardiomyotomie extramu- 52. Csendes A, Braghetto I, Korn O, Cortes C (1989) Late subjective and queuse de Heller. Mem Acad Chir Paris 27: 877 objective evaluations of antireflux surgery in patients with reflux 76a. Drummond MF, Stoddart GL, Torrance GW (1987) Methods for the esophagitis: analysis of 215 patients. Surgery 105: 374–82 economic evaluation of health care programmes. Oxford University 53. Cuschieri A (1993) Laparoscopic antireflux surgery and repair of 76b. Educational Committee of the European Association for Endoscopic 54. Cuschieri A, Shimi S, Nathansson LK (1992) Laparoscopic reduc- Surgery and other interventional techniques (E.A.E.S.). Conference tion—crural repair and fundoplication of large hiatal hernia. Am J Organizers: Neugebauer E., Troidl H., Kum C.K., Eypasch E., Miserez M., Paul A. (1995) The E.A.E.S. Consensus Development 55. Cuschieri A, Hunter J, Wolfe B, Swanstrom LL, Hutson W (1993) Conferences on Laparoscopic Cholecystectomy, Appendectomy, and Multicenter prospective evaluation of laparoscopic antireflux sur- Hernia Repair. Consensus Statements. Surg Endosc 9: 550–563 gery. Preliminary report. Surg Endosc 7: 505–510 77. Eller R, Olsen D, Sharp K, Richards W (1996) Is division of the short 56. Dahhach M, Scott GB (1994) Comparing the efficacy of cisapride gastric vessels necessary? Surg Endosc 10: 199 and ranitidine in esophagitis: a double-blind, parallel group study in 78. Eypasch EP, Stein H, DeMeester TR, Johansson K-E, Barlow AP, general practice. Br J Clin Pract 48: 10–14 Schneider GT (1990) A new technique to define and clarify esoph- 57. Dallemagne B, Weerts JM, Jehaes C, Markiewicz S, Lombard R ageal motor disorders. Am J Surg 159: 144 (1991) Laparoscopic Nissen fundoplication: preliminary report. Surg 79. Eypasch E, Spangenberger W, Neugebauer E, Troidl H (1992) Fru¨he postoperative Verbesserung der Lebensqualita¨t nach laparosko- 58. Dallemagne B, Weerts JM, Jehaes C, Markiewicz S, Lombard R pischer Cholezystektomie. In: Ha¨ring R (ed) Diagnostik und Thera- (1992) Laparoscopic Nissen fundoplication: preliminary report. Surg pie des Gallensteinleidens. Blackwell, Berlin 80. Eypasch R, Holthausen U, Wellens E, Troidl H (1994) Laparoscopic 59. Dallemagne B, Weerts JM, Jehaes C, Markiewicz S, Lombard R Nissen fundoplication: potential benefits and burdens. Update in gas- (1993) Techniques and results of endoscopic fundoplication. Endosc tric surgery. In: Ro¨her HD (ed) Grenzland Symposium, Du¨sseldorf.
60. Dallemagne B, Taziaux P, Weerts J, Jehaes C, Markiewicz S (1995) 80a. Eypasch E, Williams JI, Wood-Dauphine´e S, Ure BM, Schmu¨lling Laparoscopic surgery of gastroesophageal reflux. Ann Chir 49: 30– C, Neugebauer E, Troidl H (1995) The Gastrointestinal Quality of Life Index (GIQLI): development and validation of a new instru- 61. Dallemagne B, Weerts JM, Jehaes C, Markiewicz S (1996) Causes of failures of laparoscopic antireflux operations. Surg Endosc 10: 305– 81. Fein M, Fuchs K-H, Bohrer T, Freys S, Thiede A (1996) Fiberoptic technique for 24 hour bile reflux monitoring—standards and normal 62. DeMeester TR (1989) Prolonged esophageal pH monitoring? In: values for gastric monitoring. Dig Dis Sci 41: 216–225 Read NW (ed) Gastrointestinal motility: which tests? Wrightson Bio- 82. Feussner H, Stein HJ (1994) Minimally invasive esophageal surgery.
medical, Petersfield, England, pp 41–51 Laparoscopic antireflux surgery and cardiomyotomy. Dis Esophagus 63. DeMeester TR (1994) Antireflux surgery. J Am Coll Surg 179: 64. DeMeester TR, Johnson LF, Kent AH (1974) Evaluations of current 83. Feussner H, Petri A, Walker S, Bollschweiler E, Siewert JR (1991) operations for the prevention of gastroesophageal reflux. Ann Surg The modified AFP score: an attempt to make the results of anti-reflux surgery comparable. Br J Surg 78: 942–946 65. DeMeester TR, Johnson LS, Joseph GJ, Toscano MS, Hall AW, 84. Filipi CJ, Hinder RA, DePaula AL, Hunter JG, Swanstrom LL, Stal- Skinner DB (1976) Patterns of gastroesophageal reflux in health and ter KD (1996) Mechanisms and avoidance of esophageal perforation by bougie and nasogastric intubation. Surg Endosc 10: 198 66. DeMeester TR, Bonavina L, Albertucci N (1986) Nissen fundopli- 85. Fiorucci ST, Santucci L, Morelli A (1990) Effects of omeprazole and cation for gastroesophageal disease: evaluation of primary repair in high doses of ranitidine on gastric acidity and GOR in patients with 100 consecutive patients. Ann Surg 204: 9–20 moderate-severe oesophagitis. Am J Gastroenterol 85: 1485–1462 67. DeMeester TR, Fuchs KK, Ball CS (1987) Experimental and clinical 86. Fontaumard E, Espalieu P, Boulez J (1995) Laparoscopic Nissen- results with proximal end-to-end duodenojejunostomy for pathologic Rosetti fundoplication. Surg Endosc 9: 869–873 duodenogastric reflux. Ann Surg 206: 414–426 87. Frantzides CT, Carlson MA (1992) Laparoscopic versus conventional 68. DeMeester TR, Attwood SEA, Smyrk TC, Therkildsen DH, Hinder fundoplication. J Laparoendosc Surg 5: 137–143 RA (1990) Surgical therapy in Barrett’s esophagus. Ann Surg 212: 88. Freston JW, Malagelada JR, Petersen H, McClay RF (1995) Critical issues in the management of gastroesophageal reflux disease. Eur J 69. Demmy TL, Caron NR, Curtis JJ (1994) Severe dysphagia from an Angelchik prothesis: futility of routine esophageal testing. Ann Tho- 89. Fuchs KH (1993) Operative procedures in antireflux surgery. Endosc 69a. Dent JA, Dodds WJ, Friedman RH, Sekeguchi P, Hogen WJ, Arn- 90. Fuchs KH, DeMeester TR (1987) Cost benefit aspects in the man- dorfer EC, Petrie DJ (1980) Mechanisms of gastroesophageal reflux agement of gastroesophageal reflux disease. In: Siewert JR, in recumbent human subjects. J Clin Invest 65: 256–267 Hoelscher AH (eds) Diseases of the esophagus. Springer, Heidel- 70. Dent J, Yeomans ND, Mackinnon M, Reed W, Narielvala FM, Hetzel 91. Fuchs KH, DeMeester TR, Albertucci M (1987) Specificity and sen- parison between omeprazole and ranitidine for treatment of reflux.
sitivity of objective diagnosis of gastroesophageal reflux disease.
115. Hatlebakk JG, Berstad A, Carling L, Svedberg LE, Unge P, Ekstrom 92. Fuchs KH, DeMeester TR, Albertucci M, Schwizer W (1987) Quan- P, Halvorsen L, Stallemo A, Hovdenak N, Trondstad R (1993) Lan- tification of the duodenogastric reflux in gastroesophageal reflux soprazole versus omeprazole in short-term treatment of reflux oe- disease. In: Siewerter JR (ed) Diseases of the esophagus. Springer, sophagitis. Results of a Scandinavian multicentre trial. Scand J Gas- 93. Fuchs KH, DeMeester TR, Hinder RA, Stein HJ, Barlow AP, Gupta 116. Havelund T, Laurenssen LS, Skoubo-Kristensen R (1988) Omepra- NC (1991) Computerized identification of pathological duodenogas- zole and ranitidine in the treatment of reflux esophagitis: double tric reflux using 24-hour gastric pH monitoring. Ann Surg 213: 13– blind comparative trial. Br Med J 296: 89–92 117. Heading RC (1995) Long-term management of gastroesophageal re- 94. Fuchs KH, Freys SM, Heimbucher J (1992) Indications and technique flux disease. Scand J Gastroenterol 30: 25–30 of laparoscopic antireflux operations. In: Nabeya K, Hanaoka T, 118. Heimbucher J, Kauer WKH, Peters JH (1994) Physiologic basis of Nogami H (eds) Recent advances in diseases of the esophagus.
peptic ulcer therapy. In: Peter JH, DeMeester TR (eds) Minimally invasive surgery of the foregut. Quality Medical, St Louis, pp 199– 95. Fuchs KH, Selch A, Freys SM, DeMeester TR (1992) Gastric acid secretion and gastric pH measurement in peptic ulcer disease. Prob 119. Hendel L, Hage E, Hendel J, Stentoft P (1992) Omeprazole in the long-term treatment of severe gastro-oesophageal reflux disease in 96. Fuchs KH, Freys SM, Heimbucher J (1993) Erfahrungen mit der patients with systemic sclerosis. Aliment Pharmacol Ther 6: 565–577 laparoskopischen Technik in der Antirefluxchirurgie. Chirurg 64: 120. Hetzel DJ (1992) Controlled clinical trials of omeprazole in the long- term management of reflux disease. Digestion 51: 35–42 97. Fuchs KH, Heimbucher J, Freys SM, Thiede A (1994) Management 121. Hetzel DJ, Dent J, Reed W (1988) Healing and relapse of severe of gastro-esophageal reflux disease 1995. Tailored concept of anti- peptic esophagitis after treatment with Omeprazole. Gastroenterol- reflux operations. Dis Esophagus 7: 250–254 98. Fuchs KH, Freys SM, Heimbucher J, Fein M, Thiede A (1995) Patho- 122. Hill AD, Walsh TN, Bolger CM, Byrne PJ, Hennessy TP (1994) physiologic spectrum in patients with gastroesophageal reflux dis- Randomized controlled trial comparing Nisson fundoplication and ease in a surgical GI function laboratory. Dis Esophagus 8: 211–217 the Angelchik prosthesis. Br J Surg 81: 72–74 99. Funch-Jens P (1995) Is this a reflux patient or is it a patient with 123. Hillman AL (1994) Economic analysis of alternative treatments for functional dyspepsia with additional reflux symptoms? Scand J Gas- persistent gastroesophageal reflux disease. Scand J Gastroenterol 29: 100. Gallup Ltd. (1989) Gallup poll—UK attitudes to heartburn and re- 124. Hillman AL, Bloom BS, Fendrick AM, Schwartz JS (1992) Cost and quality effects of alternative treatments for persistent gastroesopha- 101. Galmiche JP, Brandsto¨tter G, Evreex M (1988) Combined therapy geal reflux disease. Arch Int Med 152: 1467–1472 with cisapride and cometidine in treatment of reflux esophagitis. Dig 125. Hinder RA, Filipi CJ (1992) The technique of laparoscopic Nissen fundoplication (Review). Surgical Laparosc Endosc 2: 265–272 102. Galmiche JP, Bruley des Varannes S (1994) Symptoms and disease 126. Hinder RA, Filipi CJ, Weltscher G, Neary P, DeMeester TR, Perdikis severity in gastroesophageal reflux disease. Scand J Gastroenterol G (1994) Laparoscopic Nissen fundoplication is an effective treat- ment of gastroesophageal reflux disease. Ann Surg 220: 481–483 103. Garnett WR (1993) Efficacy, safety, and cost issues in managing 127. Howard J, Heading RC (1992) Epidemiology of gastro-esophageal patients with gastroesophageal reflux disease. Am J Hosp Pharm 50: reflux disease. World J Surg 16: 288–293 128. Howden DW, Castell DO, Cohen S, Frestn IW, Orlando RC, Rob- 104. Geagea T (1991) Laparoscopic Nissen’s fundoplication: preliminary inson M (1995) The rationale for continuous maintenance treatment report on ten cases. Surg Endosc 5: 170–173 of reflux esophagitis. Arch Int Med 155: 1465–1471 105. Geagea T (1994) Laparoscopic Nissen-Rossetti fundoplication. Surg 129. Hunt RH (1995) The relationship between the control of pH and healing and symptom relief in gastro-oesophageal reflux disease.
105a. Gelfand DW (1988) Radiologic evaluation of the pharynx and esophagus. In: Gelfand DW, Richter JE (eds) Dysphagia—diagnosis 130. Incarbone R, Peters JH, Heimbucher J, Dvorak D, DeMeester CG, and treatment. Ikagu-Shoin, New York, pp 45–83 Bremner TR (1995) A contemporaneous comparison of hospital 106. Glise H (1989) Healing relapse rate and prophylaxis of reflux esoph- charges for laparoscopic and open Nissen fundoplication. Surg En- agitis. Scand J Gastroenterol 24: 57–64 107. Glise H, Hallerba¨ck B (1996) Principles of operative treatment for 131. Isal JB, Zeitun B, Barbier B (1990) Comparison of two dosage regi- GR and critical review of results of such operations. SAGES post- mens of omeprazole—10 mg once daily and 20 mg week-ends—as graduate course: problem solving in endoscopic surgery, SAGES, prophylaxis against recurrence of reflux esophagitis. Gastroenterol- 108. Glise H, Hallerba¨ck B, Johansson B (1995) Quality of life assess- 132. Jamieson GG, Watson DI, Britten-Jones R, Mitchell PC, Anvari M ments in evaluation of laparoscopic Rosetti fundoplication. Surg En- (1992) Laparoscopic Nissen fundoplication on esophageal motor 109. Glise H, Johansson B, Rosseland AR, Hallerba¨ck B, Hulte´n S, Car- 133. Jamieson CG, Watson DI, Britten-Jones R, Mitchell PC, Anvari M ling L, Knapstad LJ Gastroesophageal reflux symptoms—clinical (1994) Laparoscopic Nissen fundoplication. Ann Surg 220: 137–145 findings and effect of ranitidine treatment. (submitted) 134. Joelsson BE, DeMeester TR, Skinner DB (1982) The role of the 110. Gooszen HG, Weidema WF, Ringers J, Horbach JM, Maschee AA, esophageal body in the antireflux mechanism. Surgery 92: 417–424 Lamers CB (1993) Initial experience with laparoscopic fundoplica- 135. Joelsson S, Joelson IB, Lundberg PP, Wolan A, Wallander MA tion in The Netherlands and comparison with an established tech- (1992) Safety experience from long-term treatment with omeprazole.
nique (Belsey Mark IV). Scand J Gastroenterol 200: 24–27 111. Grande L, Toledo-Pimentel V, Manterola C, Lacima G, Ros E, Gar- 136. Jo¨nsson B, Sta¨lhammer NO (1993) The cost-effectiveness of omepra- cia-Valdecasas JC, Fuster J, Visa J, Pera C (1994) Value of Nissen zole and ranitidine in intermittent and maintenance treatment of re- fundoplication in patients with gastro-oesophageal reflux judged by flux esophagitis—ten cases of Sweden. Br J Med Econ 6: 111–126 long-term symptom control. Br J Surg 81: 548–550 137. Johansson B, Glise H, Hallerback B (1995) Thoracic herniation and 112. Hallerba¨ck B, Unge P, Carling L, Edwin B, Glise H, Havu N, Lyrena¨s intrathoracic gastric perforation after laparoscopic fundoplication.
E, Lundberg K (1994) Omeprazole or ranitidine in long term treat- ment of reflux oesophagitis. Gastroenterology 107: 1305–1311 138. Johansson J, Johnsson F, Joelsson B, Floren CH, Walther B (1993) 113. Hallerba¨ck B, Glise H, Johansson B, Ro¨dmark T. (1994) Laparoscop- Outcome 5 years after 360 degree fundoplication for gastro- ic Rossetti fundoplication. Surg Endosc 8: 1417–1422 oesophageal reflux disease. Br J Surg 80: 46–49 114. Hamelin B, Arnould B, Barbier JP (1994) Cost-effectiveness com- 139. Johansson KE, Tibbling L (1986) Maintenance treatment with Ran- itidine compared with fundoplication in gastro-oesophageal reflux 166. Liebermann DA (1987) Medical therapy for chronic reflux esopha- disease. Scand J Gastroenterol 21: 779–788 gitis: long-term follow-up. Arch Intern Med 147: 1717–1720 140. Johnsen R, Bernersen B, Straume B, Forde OH, Bostad L, Burhol PG 167. Low DG, Hill LD (1989) Fifteen to 20-year results following the Hill (1991) Prevalences of endoscopic and histological findings in sub- antireflux operation. Thorac Cardiovasc Surg 98: 444–450 jects with and without dyspepsia. Br Med J 302: 749–752 168. Lundell L, Backman L, Ekstro¨m P (1990) Omeprazole or high-dose 141. Johnsson F, Joelsson B, Gudmundson K, Greif L (1987) Symptoms ranitidine in the treatment of patients with reflux esophagitis not and endoscopic findings in diagnosis of gastro-oesophageal reflux responding to standard doses of H2-receptor antagonists. Aliment disease. Scand J Gastroenterol 22: 714–718 142. Jones R (1995) Gastro-oesophageal reflux disease in general practice.
169. Lundell L, Backman L, Ekstro¨m P (1990) Prevention of relapse of esophagitis after endoscopic healing: the efficacy of omeprazole 143. Jones R, Lydeard S (1989) Prevalence of dyspepsia in the commu- compared with ranitidine. Gastroenterology 98: A82 170. Lundell L (1992) Acid suppression in the long-term treatment of 144. Jones RH, Lydeard SE, Hobbs FRD (1990) Dyspepsia in England and peptic stricture and Barrett’s oesophagus. Digestion 51: 49–58 171. Lundell L (1994) The knife or the pill in the long-term treatment of 145. Katada N, Hinder RA, Raiser F, McBride P, Filipi CJ (1995) Lapa- gastroesophageal reflux disease? Yale J Biol Med 67: 233–246 roscopic Nissen fundoplication. Gastroenterologist 3: 95–104 172. Lundell L (1994) Long-term treatment of gastro-oesophageal reflux 146. Kauer W, Peters JH, DeMeester TR, Ireland AP, Bremner CG, Hagen disease with omeprazole. Scand J Gastroenterol 29: 74–78 JA (1995) Mixed reflux of gastric and duodenal juices is more harm- 173. Lundell L, Abrahamsson H, Ruth N, Sandberg N, Olbe LC (1991) ful to the esophagus than gastric juice alone. Ann Surg 222: 525–533 Lower esophageal sphincter characteristics and esophageal acid ex- 147. Kauer WK, Peters JH, DeMeester TR, Heimbucher J, Ireland AP, posure following partial 360° fundoplication: results of a prospective Bremner CG (1995) A tailored approach to antireflux surgery. J randomized clinical study. World J Surg 15: 115–121 174. Lundell L, Backman L, Enstro¨m D (1991) Prevention of relapse of 148. Kimmig JM (1995) Treatment and prevention of relapse of mild reflux esophagitis after endoscopic healing. The efficacity and safety oesophagitis with omeprazole and cisapride: comparison of two strat- of omeprazole compared with ranitidine. Scand J Gastroenterol 26: egies. Aliment Pharmacol Ther 9: 281–286 149. Kiviluto T, Luukkonen P, Salo J (1994) Laparoscopic gastro- 174a. Lundell L, Abrahamson H, Ruth M, Rydberg C, et al. (1996) Long- oesophageal antireflux surgery. Ann Chir Gynaecol 83: 101–106 term results of a prospective randomized comparison of total fundic 150. Klauser AG, Schindlbeck NE, Mu¨ller-Lissner SA (1990) Symptoms wrap (Nissen-Rossetti) vs. semifundoplication (Toupet) for gastro- in gastro-oesophageal reflux disease. Lancet 335: 205–208 esophageal reflux. Br J Surg 83: 830–835 151. Klinkenberg-Knol EC (1992) The role of omeprazole in healing and 174b. Jones RH, Lydeard SE, Hobes FDR, Kenkre JE, Williams EI, Jones, prevention of reflux disease. Hepatogastroenterology 39: 27–30 SJ, Repper JA, Caldow JL, Dunwoodie WMB, Bottomley JM (1990)Dyspepsia in England and Scotland. Gut 31: 402–405 152. Klinkenberg-Knol EC, Meuwissen SGM (1992) Medical therapy of 175. Luostarinen R (1993) Nissen fundoplication for reflux esophagitis.
patients with reflux oesophagitis poorly responsive to H2-receptor Long-term clinical and endoscopic results in 109 of 127 consecutive antagonist therapy. Digestion 51: 44–48 153. Klinkenberg-Knol EC, Jansen JMBJ, Festen HPM, Meuwissen SGM, 176. Luostarinen M (1995) Nissen fundoplication for gastro-oesophageal Lamers CBHW (1987) Double-blind multicentre comparison of reflux disease: long-term results. Ann Chir Gynaecol 84: 115–120 omeprazole and ranitidine in the treatment of reflux oesophagitis.
177. Luostarinen M, Isolauri J, Laitinen J (1993) Fate of Nissen fundo- plication after 20 years: a clinical, endoscopical and functional analy- 154. Klinkenberg-Knol EC, Jansen JBM, Lamers CBHW (1989) Use of omeprazole in the management of reflux oesophagitis resistant to 178. Luostarinen M, Koskinen M, Reinikainen P, Karvonen J, Isolauri J H2-receptor antagonists. Scand J Gastroenterol 24: 88–93 (1995) Two antireflux operations: floppy versus standard Nissen fun- 155. Klinkenberg-Knol EC, Festen HPM, Janesen JBM (1994) Long-term treatment with omeprazole for refractory esophagitis: efficacy and 179. Mangar D, Kirchhoff GT, Leal JJ, Laborde R, Fu E (1994) Pneumo- thorax during laparoscopic Nissen fundoplication. Can J Aneasth 41: 156. Klinkenberg-Knol EC, Festen HP, Meuwissen SG (1995) Pharmaco- logical management of gastro-oesophageal reflux disease. Drugs 49: 180. Marks R, Richter J, Rizzo J (1994) Omeprazole vs H2-receptor an- tagonists in treating patients with peptic stricture and esophagitis.
157. Koelz HR (1989) Treatment of reflux esophagitis with H2-blockers, antacids and prokinetic drugs: an analysis of randomized clinical 181. Marrero JM, de Caestecker JS, Maxwell JD (1994) Effect of famoti- trials. Scand J Gastroenterol 24: 25–36 dine on oesophageal sensitivity in gastro-oesophageal reflux disease.
158. Koop H, Arnold R (1991) Long-term maintenance treatment of reflux esophagitis with omeprazole. Prospective study with H2-blocker- 182. Matthews HR (1996) A proposed classification for hiatal hernia and resistant esophagitis. Dig Dis Sci 36: 552 gastroesophageal reflux. Dis Esophagus 9: 1–3 159. Kraemer SJ, Aye R, Kozarek RA, Hill LD (1994) Laparoscopic Hill 183. McAnena OJ, Willson PD, Evans DF, Kadirkamanathan SS, Mannur repair. Gastrointest Endosc 40: 155–159 KR, Wingte DL (1995) Physiological and symptomatic outcome af- 160. Kuster SGR, Gilroy S (1993) Laparoscopic repair of paraesophageal ter laparoscopic fundoplication. Br J Surg 82: 795–797 184. McKernan JB (1994) Laparoscopic antireflux surgery. Int Surg 79: 161. Laursen LS, Bondesen S, Hansen J (1992) Omeprazol 10 mg or 20 mg daily for the prevention of relapse in gastroesophageal reflux 185. McKernan JB (1994) Laparoscopic repair of gastroesophageal reflux disease? A double-blind comparative study. Gastroenterology 102: disease. Toupet partial fundoplication versus Nissen fundoplication.
162. Laycock WS, Mauren S, Waring JP, Trus T, Branum G, Hunter JG 186. McKernan JB, Laws HL (1994) Laparoscopic Nissen fundoplication (1995) Improvement in quality of life measures following laparo- for the treatment of gastroesophageal reflux disease. Am Surg 60: scopic antireflux surgery. Gastroenterology 108: A1128 163. Laycock WS, Oddsdottir M, Franco A, Mansour K, Hunter JG (1995) 187. McKernan JB, Champion JK (1995) Laparoscopic antireflux surgery.
Laparoscopic Nissen fundoplication is less expensive than open Bel- 188. Meyer C, de Manzini N, Rohr S, Thiry CL, Perraud V (1995–95) 164. Laycock WS, Trus TL, Hunter GE (1996) New technology for the Laparoscopic treatment of gastroesophageal reflux. Cardiopexia with division of short gastric vessels during laparoscopic Nissen fundo- the round ligament versus Nissen’s type fundoplication. Chirurgie 165. Lerut T, Coosemans W, Christiaeus R, Gruwez JA (1990) The Belsey 189. Mo¨ssner J, Ho¨lscher AH, Herz R, Schneider A (1995) A double-blind Mark IV antireflux, procedure: indications and long-term results. In: study of pantoprazole and omeprazole in the treatment of reflux Little AG, Ferguson MK, Skinner DP (eds) Diseases of the esopha- oesophagitis: a multicenter trial. Aliment Pharmacol Ther 9: 321–326 gus vol. II: Benign diseases. Futura, Mount Kisco: pp 181–188 190. Mosnier H, Leport J, Aubert A, Kianmanesh R, Sbai Idrissi MS, Guivarch M (1995) A 270 degree laparoscopic posterior fundoplasty 216. Peters JK, DeMeester TR (1995) Early experience with laparoscopic in the treatment of gastroesophageal reflux. J Am Coll Surg 181: Nissen fundoplication. Surg Technol Int IV: 109–113 217. Peters JH, Heimbucher J, Kauer WKH, Incarbone R, Bremner CG, 190a. Mosteller F (1985) Assessing Medical Technologies. National Aca- DeMeester TR (1995) Clinical and physiologic comparison of lapa- roscopic and open Nissen fundoplication. J Am Coll Surg 180: 385– 191. Mouiel J, Katkhouda N (1995) Laparoscopic Rossetti fundoplication.
218. Peterson H (1995) The prevalence of gastro-esophageal reflux dis- 192. Mouiel J, Katkhouda N, Jugenheim J (1993) Reflux gastro- oesophagie: experience laparoscopique. In: Mouiel J (ed) Actualite 219. Pitcher DE, Curet MJ, Martin DT (1994) Successful management of digestives medico-chirurgicales. 14e serie. Masson, Paris, pp 26–33 severe gastroesophageal reflux disease with laparoscopic Nissen fun- 193. Myrvold HE (1995) Laparoscopic reflux surgery; the merits and the 220. Raiser F, Hinder RA, McBride PJ, Katada N, Filipi CJ (1995) The 194. Nathanson LK, Shimi S, Cushieri A (1991) Laparoscopic ligamentum technique of laparoscopic Nissen fundoplication. Chest Surg Clin teres (round ligament) cardiopexy. Br J Surg 78: 947–951 195. Nebel OT, Fornes MF, Castsell DO (1976) Symptomatic gastro- 221. Rattner DW, Brooks DC (1995) Patient satisfaction following lapa- esophageal reflux incidence and precipitating factors. Am J Dig Dis roscopic and open antireflux surgery. Arch Surg 130: 289–294 222. Richter JE, Long JF (1995) Cisapride for gastroesophageal reflux 195a. Neugebauer E, Troidl H, Wood-Dauphinèe S, Bullinger M, Eypasch disease: a placebo-controlled, double-blind study. Am J Gastroen- E (1991) Meran Consensus Conference Quality-of-Life-Assessment in Surgery, 3–8 October 1990. Part I and Part II. Theor Surg 6: 223. Robertson CS, Evans DF, Ledingham SJ, Atkinson M (1993) Cisapride in the treatment of gastro-oesophageal reflux disease. Ali- 195b. Neugebauer E, Troidl H, Wood-Dauphinèe S, Bullinger M, Eypasch E (1992) Meran Consensus Conference Quality-of-Life-Assessment 224. Robinson M, Decktor DL, Maton PN, Sabesin S, Roufail W, Kogut in Surgery, 3–8 October 1990. Part III. Theor Surg 7: 14–38 D, Roberts W, McCullough A, Pardoll P, Saco L (1993) Omeprazole 196. Neunheim KS, Baue AE (1994) Paraesophageal hiatal hernia. In: is superior to ranitidine plus metoclopramide in the short-term treat- Shield TW (ed) General thoracic surgery. Williams & Wilkins, Phila- ment of erosive oesophagitis. Aliment Pharmacol Ther 7: 67–73 225. Ro¨sch W (1987) Erosion of the upper gastrointestinal tract. Clin 197. Nissen R (1956) Ein einfache operation sur beinflussing der reflux esophagitis. Schwz Med Wochenschr 86: 590–592 226. Rosetti N, Hell K (1977) Fundoplication for treatment of gastro- 198. Nowzaradan Y, Barnes P (1993) Laparoscopic Nissen fundoplication.
esophageal reflux in hiatal hernia. World J Surg 1: 439–444 227. Rush DR, Stelmach WJ, Young TL, Kirchdoerfer LJ, Scott-Lennox J, 199. Oddsdotti M, Franco AL, Laycock WS, Warring JP, Hunter JE Holverson HE, Sabesin SM, Nicholas TA (1995) Clinical effective- (1995) Laparoscopic repair of paraesophageal hernia. New access, ness and quality of life with ranitidine vs placebo in gastroesophageal reflux disease patients: a clinical experience network (CEN) study. J 200. Ollyo JB, Monnier P, Fontalliet C (1993) The natural history and incidence of reflux esophagitis. Gullet 3: 3–10 228. Sandmark S, Carlson R, Fauser O, Lundell L (1988) Omeprazole or 201. O’Reilly MJ, Mullins SG (1993) Laparoscopic Nissen fundoplica- ranitidine in the treatment of reflux esophagitis. Results of a double- tion: report of first 15 cases. J Laparoendosc Surg 3: 317–324 blind randomized Scandinavian multi-center study. Scand J Gastro- 202. Ortiz A, Martinez de Haro LF, Parilla P, Morales G, Molina J, Bermejo J, Liron R, Aguilar J (1996) Conservative treatment versus 229. Santag SJ (1990) The medical management of reflux oesophagitis.
antireflux surgery in Barrett’s oesophagus: long-term results of a Gastroenterol Clin North Am 19: 683–709 prospective study. Br J Surg 83: 274–278 230. Sato TL, Wu WC, Castell DO (1992) Randomized, double-blind, 203. Ovaska J, Rantala A, Laine S, Gullichsen R (1996) Laparoscopic vs placebo-controlled crossover trial of pirenzepine in patients with gas- conventional Nissen fundoplication: a prospective randomized study.
troesophageal reflux. Dig Dis Sci 37: 297–302 231. Savary N, Miller G (1978) The esophagus: handbook and atlas of 204. Palmer ED (1958) Hiatus hernia in the adult: clinical manifestations.
endoscopy. In: Fassman AG (ed) Solotherm, Switzerland, pp 135 232. Schauer PR, Meyers WC, Eubanks S (1996) Mechanism of gastric 205. Paluch TA (1996) Ambulatory laparoscopic Nissen fundoplication: a and esophageal perforations during laparoscopic Nissen fundoplica- 206. Paluch TA, Hilford MA, Feitelbert SP (1996) Laparoscopic fundo- 233. Schindlbeck NE, Klauser AG, Berghammer G, Londong W, Muller- plication and managed care: cost effective in the treatment of gas- Lissner SAL (1992) Three year follow up of patients with gastroo- troesophageal reflux. Surg Endosc 10: 187 esophageal reflux disease. Gut 33: 1016–1019 207. Paritek D, Tam PKH (1991) Results of fundoplication in a UK Pae- 234. Schwizer W, Hinder RA, DeMeester TR (1989) Does delayed gastric emptying contribute to gastroesophageal reflux disease? Am J Surg 208. Patti MG, Arcerito M, Pellegrini CA, Mulvihill SJ, Tong J, Way LW (1995) Minimally invasive surgery for gastroesophageal reflux dis- 235. Siewert JR, Feussner H (1987) Early and long-term results of anti- reflux surgery. A critical look. Bailliere clinical gastroenterology 209. Peillon C, Manouvrier JL, Labreche J, Kaeffer N, Denis P, Testart J (1994) Should the vagus nerves be isolated from the fundoplication 236. Siewert JR, Isolauri J, Feussner H (1989) Reoperation following wrap? A prospective study. Arch Surg 129: 814–818 failed fundoplication. World J Surg 13: 791 210. Pellegrini CA (1994) The role of minimal-access surgery in esoph- 237. Siewert JR, Stein HJ, Feussner H (1995) Reoperations after failed ageal disease. Curr Opin Gen Surg 117–119 antireflux procedures. Ann Chir Gynaecol 84: 122–128 211. Pellegrini CA (1995) Therapy for gastroesophageal reflux disease: 238. Sito E, Thor PJ, Maczka M, Lorens K, Konturek SJ, Maj A (1993) the new kid on the block. Editorial. J Am Coll Surg 180: 485–487 Double-blind crossover study of ranitidine and ebrotidine in gastro- 212. Peracchia A, Bancewicz J, Bonavina L (1995) Fundoplication is an esophageal reflux disease. J Physiol Pharmacol 44: 259–272 effective treatment for gastroesophageal reflux disease. Gastroenterol 239. Skinner DB, Belsey R (1967) Surgical management of esophageal reflux and hiatus hernia: long-term results with 1030 patients. J Tho- 213. Perissat J, Collet D (1995) Laparoscopic treatment of gastro- esophageal reflux disease. Surg Technol Int III: 201–205 240. Smith PM, Kerr GD, Cockel R, Ross BA, Bate CM, Brown P, Dron- 214. Perissat J, Collet D, Edye M (1992) Therapeutic laparoscopy. En- field MW, Green JRB, Hislop WS, Theodossi A, McFarland RJ, Watts DA, Taylor MD, Richardson PDI, The Restore Investigator 215. Peters JH, DeMeester TR (1995) Indications, principles of procedure Group (1994) A comparison of omeprazole and ranitidine in the selection end technique of laparoscopic Nissen fundoplication. Se- prevention or recurrence of benign esophageal stricture. Gastroen- 241. So¨lvell L (1989) The clinical safety of omeprazole. Scand J Gastro- 265a. Troidl H (1995) Endoscopic Surgery—a Fascinating Idea Requires Responsibility in Evaluation and Handling. Minimal Access Surgery, 242. Sonntag SJ (1993) Rolling review: gastroesophageal reflux disease.
266. Urschel JD (1993) Complications of antireflux surgery. Am J Surg 243. Sonntag SJ, Schnell TG, Miller TQ (1991) The importance of hiatal hernia in reflux esophagitis comapred with lower esophageal sphinc- 267. Van den Boom G, Go PMM, Hamelteman W, Dallemagne B, Ament ter pressure or smoking. J Clin Gastroenterol 13: 628–643 AJHA (1996) Cost effectiveness of medical versus surgical treatment 244. Sontag S, Robinson M, Roufail W (1992) Daily dose of omeprazole in patients with severe or refractory gastroesophageal reflux disease (OME) is needed to maintain healing an erosive esophagitis (EE).
in The Netherlands. Scand J Gastroenterol 31: 1–9 268. Van Trappen G, Rutgeer TSL, Schurmans P, Coenegrachts JL (1988) 245. Soper NJ, Brunt LM, Kerbl K (1994) Laparoscopic general surgery.
Omeprazole (40 mg) is superior to ranitidine in the short-term treat- ment of ulcerative reflux esophagitis. Dig Dis Sci 33: 523 246. Spechler SJP, Veterans Affairs Gastroesophageal Reflux Disease 269. Verlinden M (1990) Healing and prevention of relapse of reflux Study Group (1992) Comparison of medical and surgical therapy for oesophagitis by cisapride. Gastroenterol 98: A144 complicated gastroesophageal reflux disease. N Engl J Med 326: 270. Vigneri S, Termini R, Leandro G (1995) A comparison of five main- tenance therapies for reflux esophagitis. N Engl J Med 333: 1106– 247. Spechler SJ, Gordon DW, Cohen J, Williford WO, Krol W (1995) The effects of antireflux therapy on pulmonary function in patients 271. Waterfall WE, Craven MA, Allen CJ (1986) Gastroesophageal re- with severe gastroesophageal reflux disease. Am J Gastroenterol 90: flux: clinical presentations, diagnosis and management. Can Med 248. Staerk-Laursen L, Havelund T, Bondsen S (1995) Omeprazole in the 272. Watson A, Spychal RT, Brown MG, Peck N, Callander N (1995) long-term treatment of gastroesophageal reflux disease. Scand J Gas- Laparoscopic physiological antireflux procedure: preliminary results of a prospective symptomatic and objective study. Br J Surg 82: 249. Stein HJ, DeMeester TR (1992) Who benefits from antireflux study? 273. Watson DI, Reed MWR, Johnson AG (1994) Laparoscopic fundo- 250. Stein HJ, Feussner H, Siewert JR (1992) Minimally invasive antire- plication for gastroesophageal reflux. Ann R Coll Surg Engl 76: flux procedures. World J Surg 16: 347–348 251. Stein HJ, Barlow AP, DeMeester TR, Hinder RA (1992) Complica- 274. Watson DI, Gourlay R, Globe J, Reed MWR, Johnson AG, Stoddart tions of gastroesophageal reflux disease: role of the lower esophageal CJ (1994) Prospective randomized trial of laparoscopic (LNF) versus sphincter, esophageal acid/alkaline exposure, and duodenogastric re- open (ONF) Nissen fundoplication. Gut 35: S15 275. Watson DI, Jamieson GG, Devitt PG, Matthew G, Britten-Jones RE, 252. Stein HJ, Feussner H, Siewert JR (1996) Failure of antireflux surgery: Game PA, Williams RS (1995) Changing strategies in the perfor- causes and management strategies. Am J Surg 171: 36–40 mance of laparoscopic Nissen fundoplication as a result of experi- 253. Stewart KC, Urschel JD, Hallgren RA (1994) Reoperation for com- ence with 230 operations. Surg Endosc 9: 961–966 plications of the Angelchik antireflux prothesis (see comments).
276. Watson DI, Jamieson GG, Mitchell PC, Devitt PG, Britten-Jones R (1995) Stenosis of the esophageal hiatus following laparoscopic fun- 254. Stipa S, Fegiz G, Iascone C, Paolini A, Moraldi A, De Marchi C, Chieco PA (1989) Belsey and Nissen operations for gastroesopha- 277. Watson DI, Jamieson GG, Devitt OG, Mitchell PC, Game PA (1995) Paraesophageal hiatus hernia: an important complication of laparo- 255. Swanstro¨m L, Wayne R (1994) Spectrum of gastrointestinal symp- scopic Nissen fundoplication. Br J Surg 82: 521–523 toms after laparoscopic fundoplication. Am J Surg 167: 538–541 278. Watson DI, Jamieson GG, Nyers JC, Tews JP (1996) The effect of 12 256. Swanstrom L, Pennings J (1995) Safe laparoscopic dissection of the weeks Cisapride on esophageal and gastric function in patients with gastroesophageal junction. Am J Surg 169: 507–511 gastroesophageal reflux disease. Dis Esophagus 9: 48–52 257. Tack J, Coremans G, Janssens J (1995) A risk-benefit assessment of Cisaprise in the treatment of gastro-intestinal disorders. Drug Safe 278a. Watson DI, Baigrie RJ, Jamieson GG (1996) A learning curve for laparoscopic fundoplication, definable, avoidable, or a waste of time? 258. Than KBA, Silaner T (1989) A long term randomized prospective trial of the Nissen procedure versus a modified Toupet technique.
278b. Watson DI, Jamieson GG, Baigrie RJ, Mathew G, Devitt PG, Garne PA, Britten-Jones R (1996) Laparoscopic surgery for gastro- 259. Thibault C, Marceau P, Biron S, Borque RA, Beland L, Potvin M esophageal reflux: beyond the learning curve. Br J Surg 83: 1284– (1994) The Angelchik antireflux prosthesis: long-term clinical end technical follow-up. Can J Surg 37: 12–17 279. Weerts JM, Dallemagne B, Hamoir E, Demarche M, Markiewicz S, 260. Thomson ABR (1992) Medical treatment of gastro-esophageal reflux Jehaes C, Lombard R, Demoulin JC, Etienne M, Ferron PE (1993) disease: options and priorities. Hepetogastroenterology 39: 14–23 Laparoscopic Nissen fundoplication: detailed analysis of 132 pa- 261. Timmer R, Breumelhof R, Nadorp JHSM, Smout AJPM (1993) Re- tients. Surg Laparosc Endosc 3: 359–364 cent advances in the pathophysiology of gastroesophageal reflux dis- 280. Weerts JM, Dallemagne B, Jehaes C, Markiewicz S (1996) Laparo- ease. Eur J Gastroenterol Hepatol 5: 485–491 scopic management after failed reflux operations. Surg Endosc 10: 262. Toupet A (1963) Technique d’oesophago-gastroplastie avec phreno- gastropexie applique´ dans la cure radicale des hernies hiatales et 281. Wu JS, Dunnegan DL, Luttman DR, Soper NJ (1996) The influence comme comple`tement de l’ope´ration d’Heller dans les cardio- of surgical technique on early clinical outcome of laparoscopic Nis- 263. Toussaint J, Gussuin A, Deruuttre M (1991) Healing and prevention 282. Zaitown P, Rampol P, Barbier P (1989) Omeprazole (20 mg om) of a relapse esophagitis by cisapride. Gut 32: 1280–1285 versus ranitidine (150 mg diad) in reflux esophagitis. Results of a 264. Tytgat NJ, Nuo CY, Schotborgh RY (1990) Reflux esophagitis.
double-blind randomized trial. Gastroenterol Clin Biol 13: 457–462 283. Zaninotto G, DeMeester TR, Schwites W (1988) The lower esopha- 265. Tytgat GNJ, Anker-Hansen OJ, Carling L (1992) Effect of cisapride geal sphincter in health and disease. Am J Surg 155: 104–111 on relapse of reflux esophagitis, healed with an antisecretory drug.
284. Zeitoun P (1989) Comparison of omeprazole with ranitidine in the treatment of reflux oesophagitis. Scand J Gastroenterol 24: 83–87
Probiotics Significantly Reduce Symptoms of IBS, Ulcerative Colitis Medscape Medical News 2003. © 2003 Medscape Martha Kerr May 21, 2003 (Orlando) — Probiotic therapy, primarily in the form of Lactobacillus acidophilus and Bifidobacteria infantis, significantly improves symptoms and quality of life in patients with irritable bowel syndrome (IBS) and other bowel disorders, researchers