Anti-reflux surgical treatment for Barrett’s oesophagus

Authors

DOI:

https://doi.org/10.14739/2310-1210.2022.1.229215

Keywords:

hiatal hernia, Barrett’s esophagus, argon plasma coagulation, laparoscopy, fundoplication, crurophia

Abstract

The aim of the study. To improve the effectiveness of surgical treatment for patients with hiatal hernia (HH) and gastro-esophageal reflux disease (GERD) in combination with Barrett’s esophagus by developing a new method for surgical correction of the physiological cardia incompetence.

Materials and methods. The study was conducted in the Department of Digestive Surgery of the State Institution “Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine” in 2020–2021 and involved 56 patients with HH and GERD, among them axial HH was detected in 42 patients (75.0 %) – type I; paraesophageal HH – in 6 patients (10.7 %) – type II; mixed HH – in 8 patients (14.3 %) – type III (code ICD-10 – K44). The diagnosis was established using esophagogastroduodenoscopy (by high-resolution NBI mode), X-ray and histological examinations, manometry.

Results. When the diagnosis of HH in combination with Barrett’s esophagus was confirmed, a two-stage treatment was performed. During the first stage, argonoplasmic coagulation of the altered esophageal mucosa was done. Anti-reflux procedures constituted the second stage to remove HH and restore an excessive dilatation of the esophageal orifice of the diaphragm by cruroraphy with correction of anti-reflux function of the cardia by fundoplication, angle of His reconstruction and providing free food passage. 11 (19.6 %) patients underwent surgery according to a new technique that provided reliable recovery of cardia physiological functions and preservation of the anatomical relation between the diaphragm and the esophageal-gastric junction and included cruroraphy and fundoplication.

Conclusions. Thus, the proposed two-stage method of surgical treatment for patients with HH and GERD in combination with Barrett’s esophagus is highly effective. The application of the proposed method provides the elimination of pathological changes which are visible on conventional endoscopy in the esophageal mucosa, reliable restoration of cardia physiology and preservation of the anatomical relation between the diaphragm and the esophageal-gastric junction. In the post-surgical period, the proposed method of surgical treatment reduces the likelihood of recurrent failure of cardia physiological functions, dysphagia and Barrett’s esophagus.

 

Author Biographies

B. F. Shevchenko, SI “Institute of Gastroenterology of the NAMS of Ukraine”, Dnipro

MD, PhD, DSc, Professor, Senior Researcher of the Department of Surgery of Digestive Organs

N. V. Prolom, SI “Institute of Gastroenterology of the NAMS of Ukraine”, Dnipro

MD, PhD, Head the Department of Minimally Invasive Endoscopic Interventions and Instrumental Diagnostics, Senior Researcher of the Department of Surgery of Digestive Organs

O. M. Babii, SI “Institute of Gastroenterology of the NAMS of Ukraine”, Dnipro

MD, PhD, DSc, Head of the Department of Surgery of Digestive Organs, Senior Researcher

S. O. Tarabarov, SI “Institute of Gastroenterology of the NAMS of Ukraine”, Dnipro

MD, PhD, Endoscopist of the Department of Minimally Invasive Endoscopic Interventions and Instrumental Diagnostics

O. V. Zeleniuk, SI “Institute of Gastroenterology of the NAMS of Ukraine”, Dnipro

MD, PhD, Head of the Department of Surgery of Digestive Organs

References

Маtviychuk, B. O., Hurayevskyy, A. A., & Stasyshyn, A. R. (2018). Dosvid vykonannia laparoskopichnykh operatsii u khvorykh iz hryzhamy stravokhidnoho otvoru diafrahmy ta hastroezofahealnoiu refliuksnoiu khvoroboiu [Experience of performance of laparoscopic operations in patients, suffering hiatal hernias and gastroesophageal reflux disease]. Klinichna khirurhiia, 85(12), 23-25. https://doi.org/10.26779/2522-1396.2018.12.23 [in Ukrainian].

Stasyshyn, A. R. (2016). Diafrahmalni hryzhi v klinichnii khirurhichnii praktytsi [Diaphragmatic Hernia in Clinical Surgical Practice]. Halytskyi likarskyi visnyk, 23(3, Pt. 3), 57-58. [in Ukrainian].

Velygotsky, M. M., Gorbulich, O. V., & Komarchuk, V. V. (2016). Profilaktyka nespryiatlyvykh rezultativ laparoskopichnoi korektsii antyrefliuksnoi funktsii kardii pry hryzhakh stravokhidnoho otvoru diafrahmy y akhalazii stravokhodu [Prevention of adverse outcomes of laparoscopic correction of antireflux function in patients with reflux disease and achalasia]. Odeskyi medychnyi zhurnal, (3), 66-69. [in Ukrainian].

Tsygankova, O. V., Latyntseva, L. D., Batluk, T. I., Gaskina, T. K., Starichkov, A. A., & Bueverov, A. O. (2019). Gastroezofageal'naya reflyuksnaya bolezn' s vnepishchevodnymi proyavleniyami, formirovaniem pishchevoda Barretta na fone gryzhi pishchevodnogo otverstiya diafragmy [Gastroesophageal refl ux disease with non-esophageal manifestations, the formation of Barrett’s esophagus on the background of a hiatal hernia]. Eksperimental'naya i klinicheskaya gastroenterologiya, 163(3), 16-23. https://doi.org/10.31146/1682-8658-ecg-163-3-16-23 [in Russian].

Vasil'ev, Yu. V. (2006). Pishchevod Barretta: etiopatogenez, diagnostika, lechenie bol'nykh [Barrett's esophagus: etiopathogenesis, diagnosis, treatment of patients]. Trudnyi patsient, 4(7), 29-37. [in Russian].

Puchkov, K. V., Khabarova, E. V., Tishchenko, E. S., & Golubev, S. S. (2019). Rezul'taty primeneniya radiochastotnoi ablyatsii v lechenii pishchevoda Barretta [Radiofrequency ablation results in treatment of Barrett’s esophagus]. Moskovskii khirurgicheskii zhurnal, 3(67), 10-19. https://doi.org/10.17238/issn2072-3180.2019.3.10-19 [in Russian].

Baziev, A. M., Baksanocov, Z. H., Glashev, T. J., Kalibatov, R. M., & Teuvov, A. A. (2018). Opyt videoendoskopicheskikh tekhnologii pri lechenii gryzh pishchevodnogo otverstiya diafragmy i gastroezofageal'noi reflyuksnoi bolezni v usloviyakh mezhraionnoi mnogoprofil'noi bol'nitsy [Experience with video-endoscopic technologies in the treatment of hernias hiatal and gastroesophageal reflux disease in terms on general hospital]. Vestnik novykh meditsinskikh tekhnologii. Elektronnoe izdanie, (2), 68-73. https://doi.org/10.24411/2075-4094-2018-16015 [in Russian].

Nurczyk, K., Di Corpo, M. D., & Patti, M. G. (2021). Hiatal Hernia. In N. Zundel, W. S. Melvin, M. G. Patti, & D. Camacho (Eds.), Benign Esophageal Disease (pp. 59-71). Springer, Cham. https://doi.org/10.1007/978-3-030-51489-1

Rawlings, A., Soper, N. J., Oelschlager, B., Swanstrom, L., Matthews, B. D., Pellegrini, C., Pierce, R. A., Pryor, A., Martin, V., Frisella, M. M., Cassera, M., & Brunt, L. M. (2012). Laparoscopic Dor versus Toupet fundoplication following Heller myotomy for achalasia: results of a multicenter, prospective, randomized-controlled trial. Surgical Endoscopy, 26(1), 18-26. https://doi.org/10.1007/s00464-011-1822-y

Morales-Conde, S., Lopez Bernal, F., & Alarcón, I. (2021). Minimally Invasive Surgery of Paraesophageal Hernias. In M. Asunción Acosta, M. A. Cuesta, & M. Bruna (Eds.), Atlas of Minimally Invasive Techniques in Upper Gastrointestinal Surgery (pp. 39-47). Springer, Cham. https://doi.org/10.1007/978-3-030-55176-6_6

Novikov, V. N., Sandratskaya, A. V., Yakovleva, E. V., & Vologzhanina, L. G. (2018). Diagnostika i lechenie pishchevoda Barretta [Diagnostics and treatment of Barret's esophagus]. Klinicheskaya i eksperimental'naya khirurgiya. Zhurnal imeni akademika B. V. Petrovskogo, 6(2), 32-39. https://doi.org/10.24411/2308-1198-2018-12004 [in Russian].

Malynovskyi, A. V., & Grubnik, V. V. (2017). Sravnenie laparoskopicheskoi nenatyazhnoi karkasnoi alloplastiki i plastiki oblegchennym setchatym implantatom gigantskikh gryzh pishchevodnogo otverstiya diafragmy: otdalennye rezul'taty prospektivnogo randomizirovannogo issledovaniya [Laparoscopic tension-free framed versus lightweight mesh repair for giant hiatal hernias: early results of prospective randomized trial]. Khirurhiia Ukrainy, (1), 23-29. [in Russian].

Li, Z., Zhang, R., Han, X., Li, C., Li, W., Li, C., & Ji, F. (2021). Clinical observation of different anti-reflux methods in the treatment of gastroesophageal reflux disease with hiatus hernia. Research Square. https://doi.org/10.21203/rs.3.rs-199899/v1

Yanes, M., Santoni, G., Maret-Ouda, J., Ness-Jensen, E., Färkkilä, M., Lynge, E., Pukkala, E., Romundstad, P., Tryggvadóttir, L., von Euler -Chelpin, M., & Lagergren, J. (2021). Survival after antireflux surgery versus medication in patients with reflux oesophagitis or Barrett's oesophagus: multinational cohort study. British Journal of Surgery, 108(7), 864-870. https://doi.org/10.1093/bjs/znab024

Renzi, A., Di Sarno, G., d'Aniello, F., Brillantino, A., Minieri, G., Coretti, G., Barbato, D., & Barone, G. (2021). Complete Fundus Mobilization Reduces Dysphagia After Nissen Procedure. Surgical Innovation, 28(3), 272-283. https://doi.org/10.1177/1553350620971174

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Published

2022-01-26

How to Cite

1.
Shevchenko BF, Prolom NV, Babii OM, Tarabarov SO, Zeleniuk OV. Anti-reflux surgical treatment for Barrett’s oesophagus. Zaporozhye Medical Journal [Internet]. 2022Jan.26 [cited 2024Nov.24];24(1):30-7. Available from: http://zmj.zsmu.edu.ua/article/view/229215

Issue

Vol. 24 No. 1 (2022)

Section

Original research

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