-Original-

Characteristics and Outcomes of Laparoscopic Surgery in Patients with Gastroesophageal Reflux and Related Disease: A Single Center Experience

Tsutomu Nomura¹, Katsuhiko Iwakiri², Takeshi Matsutani¹, Nobutoshi Hagiwara¹, Itsuo Fujita¹, Yoshiharu Nakamura¹, Yoshikazu Kanazawa¹, Hiroshi Makino³, Noriyuki Kawami², Masao Miyashita⁴ and Eiji Uchida¹

¹Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
²Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
³Department of Surgery, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
⁴Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan

Background: Laparoscopic anti-reflux surgery (LARS) is generally the treatment of choice for patients with gastroesophageal reflux disease (GERD). This report describes our experiences in performing LARS on patients with GERD, and focuses retrospectively on the pathophysiology of individual patients and the current status of Japanese patients who have undergone LARS. We demonstrate that patients with non-erosive reflux disease resistant to proton pump inhibitors (PPI-resistant NERD) and high-risk giant hernia, whom we are sometimes hesitant to treat surgically, can be safely and successfully treated with LARS (depending on the pathophysiology of individual patients).
Methods: Between January 2007 and June 2015, 37 patients underwent LARS at Nippon Medical School Hospital. These patients were retrospectively subgrouped according to pathophysiology; 9 of them had PPI-resistant NERD (Group A), 19 had a giant hiatal hernia (Group B), and 9 had erosive esophagitis (Group N). Patient characteristics, intraoperative bleeding, operation duration, perioperative complications, and length of hospital stay were determined, along with symptomatic outcomes and patient satisfaction.
Results: Patients in Group A were the youngest (average: 43.9 years), and those in Group B were the oldest (75.9 years) (P=0.002). The percentage of high-risk patients, as determined by performance status (P=0.047) and American Society of Anesthesiologists physical status classification (P=0.021), was highest in Group B, whereas the percentage of patients with mental disorders was highest in Group A (P=0.012). There were no significant differences among the groups in terms of intraoperative bleeding, surgery duration, or postoperative hospital stay. Thirty-three patients (89.2%), including all 19 in Group B, expressed excellent or good postoperative satisfaction levels.
Conclusions: The characteristics of the patients who underwent LARS at our hospital differed according to pathophysiology and from those in western countries. Satisfactory outcomes depended on the pathophysiology of individual patients.

J Nippon Med Sch 2017; 84: 25-31

Keywords
laparoscopic anti-reflux surgery, proton pump inhibitor resistant non-erosive reflux disease, giant hiatal hernia

Correspondence to
Tsutomu Nomura, Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
nomura-t@nms.ac.jp

Received, September 24, 2016
Accepted, November 24, 2016