Fundoplication is a common surgical procedure for gastroesophageal reflux Disease (GERD). Recently the procedure has been performed with increased frequency laparoscopically. The aim of this study is to compare laparoscopic Nissen fundoplication (LNF) and open Nissen fundoplication (ONF) for GERD in children. We studied retrospectively the 88 pediatric patients who underwent the Nissen fundoplication for GERD as primary antireflux surgery from 1994 and 2009. ONF was performed in 34 cases and LNF was in 54 cases. 58 patients have neurologic impairment. Time to initial food intake after the surgery were reduced in the LNF group (p = 0.032).Recurrent GERD symptom occurred in one patient in LNF group and four patients in ONF group within 1 year after the surgery (p = 0.012). There were no statistically significant differences in post operative morbidity and mortality between both groups. In conclusion, our practice of Nissen fundoplication indicates that LNF takes priority in most pediatric patients.
Child ; Eating ; Fundoplication ; Gastroesophageal Reflux ; Humans ; Laparoscopy ; Retrospective Studies

Though efficient acid suppression with proton pump inhibitors (PPIs) remains the mainstay of treatment of gastroesophageal reflux disease (GERD), some of the patients showed refractory response to PPIs, necessitating further intervention. After increasing dose of PPIs and other kinds of pharmacological intervention adopting prokinetics or others, variable endoscopic treatments are introduced for the treatment of these refractory cases. The detailed introduction regarding endoscopic treatment for GERD is forwarded in this review article. Implantation of reabsorbable or synthetic materials in the distal esophagus was tried in vain and is expelled from the market due to limited efficacy and serious complication. Radiofrequency energy delivery (Stretta) and transoral incisionless fundoplication (EsophyX) are actively tried currently.
Esophagus ; Fundoplication ; Gastroesophageal Reflux ; Humans ; Proton Pump Inhibitors

PURPOSE: Laparoscopic fundoplication is considered the standard surgical treatment for gastroesophageal reflux disease (GERD) in Western countries. However, some patients experience poor surgical outcomes with this procedure. The study aimed to identify the predictive factors of the surgical outcomes of laparoscopic Nissen fundoplication for the treatment of Korean GERD patients. METHODS: Sixty-one patients with GERD were treated using laparoscopic Nissen fundoplication between November 2012 and February 2015. Symptom control rates were compared according to clinical and surgical factors to identify predictive factors of successful surgical outcomes. RESULTS: Thirty-five men and 26 women were enrolled. Preoperatively, typical symptoms were present in 60 patients (98%), while atypical symptoms were present in 40 patients (66%). Postoperatively, typical symptoms were controlled in 51 of 60 patients (85.0%), while atypical symptoms were controlled in 33 of 40 patients (82.5%). Overall, at 6 months postsurgery, 54 (88.5%) reported some resolution of GERD symptoms, with 48 (78.7%) achieving complete control. Patients who exhibited a good response to proton pump inhibitor therapy had a significantly greater rate of complete symptom control (P = 0.035). CONCLUSION: Laparoscopic fundoplication is effective for controlling GERD symptoms. Response to preoperative proton pump inhibitor was a predictor of successful outcome.
Female ; Fundoplication* ; Gastroesophageal Reflux* ; Humans ; Korea* ; Laparoscopy ; Male ; Proton Pumps

PURPOSE: Laparoscopic total fundoplication is the standard surgery for gastroesophageal reflux disease. However, partial fundoplication may be a viable alternative. Here, we conducted a nationwide survey of partial fundoplication in Korea. METHODS: The Korean Anti-Reflux Surgery study group recorded 32 cases of partial fundoplication at eight hospitals between September 2009 and January 2016. The surgical outcomes and postoperative adverse symptoms in these cases were evaluated and compared with 86 cases of total fundoplication. RESULTS: Anterior partial fundoplication was performed in 20 cases (62.5%) and posterior in 12 (37.5%). In most cases, partial fundoplication was a secondary procedure after operations for other conditions. Half of patients who underwent partial fundoplication had typical symptoms at the time of initial diagnosis, and most of them showed excellent (68.8%), good (25.0%), or fair (6.3%) symptom resolution at discharge. Compared to total fundoplication, partial fundoplication showed no difference in the resolution rate of typical and atypical symptoms. However, adverse symptoms such as dysphagia, difficult belching, gas bloating and flatulence were less common after partial fundoplication. CONCLUSION: Although antireflux surgery is not popular in Korea and total fundoplication is the primary surgical choice for gastroesophageal reflux disease, partial fundoplication may be useful in certain conditions because it has less postoperative adverse symptoms but similar efficacy to total fundoplication.
Deglutition Disorders ; Diagnosis ; Eructation ; Flatulence ; Fundoplication* ; Gastroesophageal Reflux ; Humans ; Korea*

Obesity is one of the most significant causes of GERD. Nissen fundoplication is a surgical procedure that's performed world widely for treating patients with GERD and a hiatal hernia and who are intractable to medical therapy. However, Nissen fundoplication may have technical difficulties in morbidly obese patients due to the huge perigastric, intraabdominal fat tissue and hepatomegaly. During the laparoscopic Roux-en-Y Gastric Bypass (LRYGB) procedure, the stomach was divided into the gastric pouch and the remnant stomach by vertiacally stapling at the angle of His. The posterior gastric wall and hiatus were easily exposed even when there was huge deposits of perigatric and intraabdominal fat tissue. We report here on a case of concomitant hiatal hernia repair with LRYGB in a morbidly obese patient.
Fundoplication ; Gastric Bypass ; Gastric Stump ; Gastroesophageal Reflux ; Hepatomegaly ; Hernia, Hiatal ; Humans ; Obesity ; Obesity, Morbid ; Stomach

There is a growing evidence that gastroesophageal reflux disease is related to several upper gastrointestinal cancers, mainly the esophageal adenocarcinoma and a certain type of gastric cardia adenocarcinoma. Currently, the incidence of gastroesophageal reflux disease is rapidly increasing in Korea. Therefore, there is a possibility of such increasing cancerous incidents, similar to the western worlds. In this article, the relationship between gastroesophageal reflux disease and several upper gastrointestinal cancers, the components of refluxate which has possible causal relationship with carcinogenesis, and the clinical implications of such relationship in the management of gastroesophageal reflux disease patients are discussed through the review of literature.
Adenocarcinoma ; Cardia ; Fundoplication ; Gastroesophageal Reflux ; Gastrointestinal Neoplasms ; Humans ; Incidence ; Korea ; Western World

Gas-bloat syndrome is a characteristic disease that developed in patients who had symptoms severe enough to warrant surgery for refractory refiux esophagitis. During the first few months, most of patients have significant symptoms and gradually have been improved except some cases. Although the underlying pathophysiology is uncatain, too tense fundoplication could result in an one-way valve peventing most patients from belching or vomiting. This syndrome has been reported in western country for many years but not yet in Korea. We report a case of gas-bloat syndrome after fundoplication for sevete reflux esophagitis and hiatal hemia.
Eructation ; Esophagitis ; Esophagitis, Peptic ; Fundoplication ; Gastroesophageal Reflux ; Humans ; Korea ; Transcutaneous Electric Nerve Stimulation ; Vomiting

Electrical stimulation therapy (EST) of the lower esophageal sphincter is a relatively new technique for the treatment of gastroesophageal reflux disease (GERD) that may address the need of GERD patients, unsatisfied with acid suppressive medication and concerned with the potential risks of surgical fundoplication. In this paper we review available data about EST for GERD, including the development of the technique, implant procedure, safety and results from open-label trials. Two short-term temporary stimulation and long-term open-label human trials each were initiated to investigate the safety and efficacy of EST for the treatment of GERD and currently up to 2 years follow-up results are available. The results of EST are promising as the open-label studies have shown that EST is a safe technique with a significant improvement in both subjective outcomes of symptoms and objective outcomes of esophageal acid exposure in patients with GERD. However, long-term data from larger number of patients and a sham-controlled trial are required before EST can be conclusively advised as a viable treatment option for GERD patients.
Electric Stimulation Therapy* ; Esophageal Sphincter, Lower ; Follow-Up Studies ; Fundoplication ; Gastroesophageal Reflux* ; Humans

PURPOSE: This study was conducted to identify potential dangers involved in procedure and evaluate complications of percutaneous endoscopic gastrostomy (PEG) comparing to surgical gastrostomy (SG). METHODS: A retrospective study of 66 children with feeding gastrostomy between 1994 and 2002 was done. RESULTS: Of 66 children, 23 (mean age 29 months) had PEG and 43 (mean age 49 months) had SG. 31 cases of SG group had fundoplication for gastroesophageal reflux disease. PEG groups were followed up with an average 13 months and SG groups with 21 months. Major complications occurred in 33% of PEG group (8/23) and 55% of SG group (24/43). Major complications were significantly lower in PEG group than SG group and minor complications, too (p<0.05). Of major complications, aspiration pneumonia was the most common but paralytic ileus was significantly higher in SG group than PEG group. 8 patients died of underlying disease but not related to gastrostomy. Removals of stomata were done in 5 of PEG group and 3 of SG group. GER recurred in 25% of SG group with fundoplication and newly developed in 17% of SG group. GER persisted in 17% and newly developed in 5% of PEG group. CONCLUSION: The gastrostomy was a significant procedure with the potential to produce complications. PEG is recommended as an initial procedure in children requiring a feeding gastrostomy but should be considered a major undertaking.
Child* ; Fundoplication ; Gastroesophageal Reflux ; Gastrostomy* ; Humans ; Intestinal Pseudo-Obstruction ; Mortuary Practice ; Pneumonia, Aspiration ; Retrospective Studies

The surgical indications for the treatment of gastroesophageal reflux disease (GERD) in patients with esophageal motility disorders have been debated. We report a case of antireflux surgery performed in a patient with absent esophageal motility as categorized by the Chicago classification (2011). A 54-year-old man underwent laparoscopic Toupet fundoplication due to apparent GERD and desire to discontinue all medications. After surgery, his subjective symptoms improved. Furthermore, objective findings including manometry and 24-hour pH-metry also improved. In our experience, antireflux surgery can improve GERD symptoms patients, even with absent esophageal motility.
Classification ; Esophageal Motility Disorders ; Fundoplication* ; Gastroesophageal Reflux* ; Humans ; Laparoscopes ; Manometry ; Middle Aged