Short-term results of laparoscopic anti-reflux surgery with the RefluxStop device in patients with gastro-esophageal reflux disease and ineffective esophageal motility

Yannick Fringeli; Ioannis Linas; Ulf Kessler; Joerg Zehetner

doi:10.1007/s00423-024-03264-5

Short-term results of laparoscopic anti-reflux surgery with the RefluxStop device in patients with gastro-esophageal reflux disease and ineffective esophageal motility

Langenbecks Arch Surg. 2024 Feb 29;409(1):78. doi: 10.1007/s00423-024-03264-5.

Authors

Yannick Fringeli¹, Ioannis Linas², Ulf Kessler¹, Joerg Zehetner³

Affiliations

¹ Department of Visceral Surgery, Hirslanden Clinic Beau-Site, 3013, Bern, Switzerland.
² Department of Gastroenterology, Hirslanden Clinic Beau-Site, 3013, Bern, Switzerland.
³ Department of Visceral Surgery, Hirslanden Clinic Beau-Site, 3013, Bern, Switzerland. joerg.zehetner@hirslanden.ch.

Abstract

Purpose: In gastro-esophageal reflux disease (GERD) requiring surgical treatment, concomitant ineffective esophageal motility (IEM) is a decisive factor in surgical planning, due to concern regarding dysphagia. Anti-reflux surgery with the RefluxStop device is a promising technique. We assessed initial feasibility and clinical outcomes of RefluxStop surgery in patients with GERD and IEM.

Methods: Retrospective analysis of patients with GERD, hiatal hernia (HH), and IEM, who underwent surgery with RefluxStop at our institution and achieved 12-month follow-up. Technique feasibility was assessed, in addition to symptom resolution (GERD-HRQL questionnaire), adverse events, HH recurrence, dysphagia, and patient satisfaction. Placement of the device was confirmed by video fluoroscopy on postoperative day 1, and at 3 and 12 months.

Results: Between June 2020 and November 2022, 20 patients with IEM underwent surgery with RefluxStop and completed 12-month follow-up. All patients reported typical symptoms of GERD, and 12 had preoperative dysphagia. The median HH length was 4.5 cm (IQR, 3.75-5). The median operating time was 59.5 min (IQR, 50.25-64) with no implant-related intra- or postoperative complications. No HH recurrence was observed. One patient reported persistent left-sided thoracic pain at 11 months post-surgery, which required diagnostic laparoscopy and adhesiolysis. Three patients reported severe postoperative dysphagia: balloon dilatation was performed towards resolution. The mean GERD-HRQL scores improved (from 40.7 at baseline to 4.8 at 3 months and 5.7 at 12 months (p <0.001)).

Conclusion: RefluxStop surgery was feasible and offered effective treatment for this group of patients with GERD and IEM. All patients had complete resolution or significant improvement of GERD symptoms, and 90% of them were satisfied with their quality of life 1 year after surgery.

Keywords: Anti-reflux surgery; Esophageal dysmotility; Gastro-esophageal reflux disease; Hiatal hernia; Ineffective esophageal motility; RefluxStop.

MeSH terms

Deglutition Disorders* / complications
Deglutition Disorders* / surgery
Gastroesophageal Reflux* / complications
Gastroesophageal Reflux* / surgery
Hernia, Hiatal* / complications
Hernia, Hiatal* / surgery
Humans
Laparoscopy* / methods
Quality of Life
Retrospective Studies
Treatment Outcome