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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Nov 27, 2016; 8(11): 719-728
Published online Nov 27, 2016. doi: 10.4240/wjgs.v8.i11.719
Pre-operative clinical and instrumental factors as antireflux surgery outcome predictors
Salvatore Tolone, Giorgia Gualtieri, Edoardo Savarino, Marzio Frazzoni, Nicola de Bortoli, Manuele Furnari, Giuseppina Casalino, Simona Parisi, Vincenzo Savarino, Ludovico Docimo
Salvatore Tolone, Giorgia Gualtieri, Giuseppina Casalino, Simona Parisi, Ludovico Docimo, Division of General and Bariatric Surgery, Second University of Naples, 80131 Naples, Italy
Edoardo Savarino, Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, 35121 Padua, Italy
Marzio Frazzoni, Division of Gastroenterology, Baggiovara Hospital, 41121 Modena, Italy
Nicola de Bortoli, Division of Gastroenterology, Department of Internal Medicine, University of Pisa, 56126 Pisa, Italy
Manuele Furnari, Vincenzo Savarino, Division of Gastroenterology, Department of Internal Medicine, University of Genoa, 16123 Genoa, Italy
Author contributions: Tolone S contributed to conception and design and drafting the article; Gualtieri G contributed to drafting the article; Savarino E, Frazzoni M, de Bortoli N, Furnari M, Casalino G and Parisi S contributed to acquisition and interpretation of data, and revisited it critically for important intellectual content; Savarino V and Docimo L gave final approval of the version to be published.
Conflict-of-interest statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Salvatore Tolone, MD, PhD, Second University of Naples, Division of General and Bariatric Surgery, Via Pansini 5, 80131 Naples, Italy. salvatore.tolone@unina2.it
Telephone: +39-81-5666658 Fax: +39-81-5666237
Received: March 29, 2016
Peer-review started: April 4, 2016
First decision: May 23, 2016
Revised: July 20, 2016
Accepted: September 21, 2016
Article in press: September 22, 2016
Published online: November 27, 2016
Abstract

Gastroesophageal reflux disease (GERD) is nowadays a highly prevalent, chronic condition, with 10% to 30% of Western populations affected by weekly symptoms. Many patients with mild reflux symptoms are treated adequately with lifestyle modifications, dietary changes, and low-dose proton pump inhibitors (PPIs). For those with refractory GERD poorly controlled with daily PPIs, numerous treatment options exist. Fundoplication is currently the most commonly performed antireflux operation for management of GERD. Outcomes described in current literature following laparoscopic fundoplication indicate that it is highly effective for treatment of GERD; early clinical studies demonstrate relief of symptoms in approximately 85%-90% of patients. However it is still unclear which factors, clinical or instrumental, are able to predict a good outcome after surgery. Virtually all demographic, esophagogastric junction anatomic conditions, as well as instrumental (such as presence of esophagitis at endoscopy, or motility patterns determined by esophageal high resolution manometry or reflux patterns determined by means of pH/impedance-pH monitoring) and clinical features (such as typical or atypical symptoms presence) of patients undergoing laparoscopic fundoplication for GERD can be factors associated with symptomatic relief. With this in mind, we sought to review studies that identified the factors that predict outcome after laparoscopic total fundoplication.

Keywords: Gastroesophageal reflux disease, Antireflux surgery, Outcome predictors, Fundoplication, Nissen, Laparoscopy, High resolution manometry, Impedance-pH monitoring

Core tip: Fundoplication is currently the most commonly performed antireflux operation for management of gastroesophageal reflux disease (GERD). Outcomes described in current literature following laparoscopic fundoplication indicate that it is highly effective for treatment of GERD. However it is still unclear which factors, clinical or instrumental, are able to predict a good outcome after surgery. Anatomical conditions seem to not be a risk factor for poor outcome. The predictability of success following laparoscopic fundoplication seems to be directly proportional to the degree of certainty that gastroesophageal reflux is the underlying cause of the patient’s complaints. Thus, performing an accurate pre-operative clinical and instrumental evaluation is mandatory.