2005 SAGES Abstracts

POSTER ABSTRACTS
Carvalho PhD, Debora S Carvalho,Gildo O Passos Jr,Frederico
P Santos,Gilvan Loureiro MD,Carlos H Ramos MD,Frederico W
Silva MD, Clínica Cirúrgica Videolaparoscópica Gustavo
Carvalho, UPE - Universidade de Pernambuco, Recife - BRAZIL
BACKGROUND: Barrett´s Esophagus (BE) is a complication of
Gastro-esophageal Reflux Disease (GERD) and can be a premalignant
condition. Anti-reflux laparascopic surgeries (ARLS)
significantly correct physiological and anatomical abnormalities
in patients with GERD; nevertheless, there is no consensus
with respect to its effectiveness in preventing malignant transformation
in patients with BE. The impact of ARLS on those
suffering from BE and in particular its effect not only on the
regression of metaplasia but also on the progression of metaplasia
and dysplasia towards adenocarcinoma, remain barely
transparent.
OBJECTIVE: To analyze clinical, endoscopic and histopathological
results after ARLS in patients suffering from BE.
PATIENTS & METHOD: In the period from January 2000 to
June 2004, a group of 142 patients suffering from GERD
underwent ARLS performed by the same surgeon. Among
these, 42 patients (29,5%) suffered from BE. All the patients
underwent Nissen fundoplication by laparascopic means.
There were no conversions to open surgery. All patients were
discharged within 24 hours. Post-operative follow-up using
endoscopy and biopsy was carried out in all 42 patients with
BE.
RESULTS: After follow-up which varied from 3 to 40 months,
symptomatic control was good in most patients: three patients
developed recurrence of the symptoms and are making regular
use of proton pump inhibitor, thus BE remains unaltered in
these patients. Partial or complete regression of BE occurred
in 25 patients with 14 of them not showing any further signs of
BE in endoscopic or histopathological examination. And in 1
patient who remained asymptomatic after surgery, the degree
of dysplasia increased, which led to his undergoing endoscopic
mucosectomy of the BE area. No patient presented adenocarcinoma
after surgery. No-one died or suffered any significant
complication as a result of surgery.
CONCLUSIONS: Laparoscopic Nissen fundoplication is safe
and effective in the symptomatological control of a significant
number of patients with BE. Regression of BE occurred at a
randomly high percentage level in patients operated despite
the control of GERD attained by most patients.
P012–Posters of Distinction
NAUSEA AND GASTROESOPHAGEAL REFLUX DISEASE: IS
SURGERY THE CAUSE OR THE CURE, Yashodhan S
Khajanchee MD, Barbara Lockhart RN,Lee L Swanstrom MD,
Department of MIS, Legacy Health System, Portland, OR
Objective: Nausea is a common symptom in GERD patients
referred for antireflux surgery (ARS). Postoperative nausea can
lead to devastating complications and failure of the surgery.
The aim of this study is to determine the incidence and patient
characteristics of nausea as a presenting complaint and to
document the effect of ARS on it.
Methods: 671 patients undergoing ARS were selected from a
prospective database of patients undergoing various
esophageal surgeries at our institution. Exclusion criteria were:
surgery before 1993 (early technique), Heller myotomy, < 6
months follow-up, or failure to complete nausea portion of the
symptom assessment tool. Symptoms were recorded on a
scale of 0-4 with higher ordinal values representing greater
frequency of symptoms. Logistic regression modeling was
performed to identify factors most significant for persistent
nausea following ARS. Comparisons were done using chisquare
test or t-test as appropriate.
Results: Overall 185 (27.2 %) patients had some nausea preoperatively
(mean severity score 2.0 [±0.88]). Women, younger
patients, and patients with other associated GI symptoms or
PEH had significantly higher incidence of nausea (p < 0.05).
After surgery 498 (74.2%) patients had some degree of nausea
at early post-operative visit (median 3.5 weeks). At long-term
follow-up (median 9 months) 149 (22.2%) patients experienced
nausea (45 persistent nausea, 104 new onset nausea, overall
mean severity score 1.75 [±0.82]). Odds of persistent nausea
were higher among women (odds ratio [OR] 3.5), in patients
undergoing Toupet repair (OR-6.5), Collis gastroplasty (OR 3.4),
or redo ARS (OR 1.5), and in those having preoperative nausea
(OR 1.14) or functional GI disorders (OR 1.17). However, none
of the factors were found to be statistically significant.
Conclusion: Nausea is a frequent presenting component of
GERD. It can also be a devastating postoperative complication
leading to failure. Our data shows that majority (75.6%) of
patients with preoperative nausea are cured with fundoplication.
However, there are a significant number of patients who
develop new onset nausea after surgery. It is difficult to predict
who will develop nausea after surgery, so surgeons should
counsel all patients about this possibility.
P013–Posters of Distinction
LARYNGOPHARYNGEAL REFLUX CAN EXIST WITH NORMAL
DISTAL ESOPHAGEAL ACID EXPOSURE, Rami E Lutfi MD,
Alfonso Torquati MD,Nikhilesh Sekhar MD,William O Richards
MD, Vanderbilt University
Laryngopharyngeal reflux (LPR) has been detected in patients
with gastroesophageal reflux disease (GERD). The prevalence
of GERD in patients with LPR remains unknown.
Aim: to determine if pathologic proximal esophageal reflux
can exist without pathologic distal reflux.
Methods: Database was reviewed for triple probe pH studies.
Each included manometry and 24-hr pH study using 3 probes
(distal, middle, located 5 and 15cm proximal to lower
esophageal sphincter, LES, and extraesophageal located at
2cm above the upper sphincter). Comparison was made using
Student t test for continuous, and chi square for independent
variables.
Results: 113 triple probe studies were performed for different
LPR symptoms (laryngitis, 31%; chronic cough, 19%; hoarseness,
9%; vocal cord nodules, 11%; and subglottic stenosis,
4%). Pathologic LPR was defined according to our previous
study on healthy volunteers as >4 reflux episodes detected by
the extraesophageal probe. 45 patients had pathologic LPR; of
those, only 24 (53%) had abnormal distal acid exposure time
(>4.1%) with elevated DeMeester score (¡Y22). The difference
in incidence of abnormal distal acid exposure or DeMeester
score was not statistically significant between patients with or
without pathologic LPR. Mean DeMeester score and distal acid
exposure time were both higher in LPR group, but the difference
did not reach statistical significance (34+/-30 vs. 27+/-34,
p=0.238, and 6.5+/-5.9% vs. 5.2+/-6.4, p=0.277, respectively).
Using t test, LES pressure, contraction amplitudes, and peristalsis
were compared between the same two groups (with or
without LPR); no statistically significant difference was found.
No correlation was found between the severity of LPR and
GERD severity when Pearson Correlation test was run between
the number of proximal reflux episodes and DeMeester score
(r=0.073, p=0.443). Conclusion: Pathologic LPR can exist without
pathologic distal acid exposure. To accurately diagnose
LPR, a hypopharyngeal sensor must be used with the standard
distal pH sensors located at 5, and 15 cm from the LES.
P014–Posters of Distinction
POUCH ENLARGEMENT AND BAND SLIPPAGE, TWO DIFFER-
ENT ENTITIES, Frederico Moser MD, Santiago Horgan MD,M V
Gorodner MD,C Galvani MD,M Baptista MD,A. Arnold MD,
University of Illinois at Chicago
Background: pouch enlargement (PE) and band slippage (BS)
are the most common late complications of the laparoscopic
adjustable gastric banding (LAGB). Often, confusion exists
among surgeons regarding the denomination or even the
treatment for these two different entities.
Objectives: to establish the differences in clinical presentation,
radiological features and management between PE and BS.
Hypothesis: a) PE can be managed non operatively (band
deflation); b) BS is an acute complication that requires surgical
treatment; c) tailored adjustment allows earlier diagnosis of PE
in asymptomatic patients.
Methods: From 3/01 to 7/04, 470 patients underwent LAGB
placement. Barium swallow was performed pre, postoperatively
and during band adjustments (?tailored adjustment?). PE
was defined as dilatation of the pouch; BS was considered
when band and stomach were prolapsed. PE was divided in 4
radiologic types. 1) PE, band 45?; 2) PE, covering the band,
band 45?; 3) PE, band 0? and 4) PE, band < 0?.
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SAGES 2005
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