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Trends in laparoscopic anti-reflux surgery: a Korea nationwide study

Authors
Kim, Min SeoOh, YoujinLee, Jun-HyunPark, Joong-MinKim, Jin-JoSong, Kyo YoungRyu, Seung WanSeo, Kyung WonKim, Hyoung-IlKim, Dong JinPark, SungsooHan, Sang-UkKorean Anti-refux Surgery Study Group
Issue Date
Aug-2021
Publisher
Springer Verlag
Keywords
Laparoscopic fundoplication; Gastroesophageal reflux disease; Trend; Nissen fundoplication; Dysphagia; Complications
Citation
Surgical Endoscopy, v.35, no.8, pp.4241 - 4250
Indexed
SCIE
SCOPUS
Journal Title
Surgical Endoscopy
Volume
35
Number
8
Start Page
4241
End Page
4250
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/33952
DOI
10.1007/s00464-020-07909-6
ISSN
0930-2794
Abstract
Background In 2014, the results derived from the nationwide data of the Korean Anti-reflux Surgery Study (KARS) demonstrated short-term feasibility and safety of anti-reflux surgery. This study aimed to update the longer-term safety and feasibility of laparoscopic anti-reflux surgery up to 1-year follow-up with the KARS nationwide cohort. Methods The data of 310 patients with GERD who received anti-reflux surgery up to 2018 were analyzed. Baseline patient characteristics, postoperative symptom resolution, and postoperative complications were evaluated at postoperative 3 months and 1 year using the questionnaire designed by KARS. We divided the patients into two groups according to the operation period (up to and after 2014) to identify changes in the trends of the characteristics of surgical patients and operative qualities. Results The typical preoperative symptoms were present in 275 patients (91.7%), and atypical symptoms were present in 208 patients (71.0%). Ninety-seven (35.5%) and 124 patients (46.1%) had inadequate PPI responses and hiatal hernia, respectively. At postoperative 1 year, typical and atypical symptoms were either completely or partially controlled in 90.3% and 73.5.0% of patients, respectively. Moderate-to-severe dysphagia, inability to belch, gas bloating, and flatulence at postoperative 1 year were identified in 23.5%, 29.4%, 23.2%, and 22.0% of patients, respectively. The number of surgical patients continuously increased from 2011 to 2018 in Korea. The proportion of patients with hiatal hernia and comorbidities increased (p < 0.01, p = 0.053), and the operation time decreased significantly (p < 0.01) in the late period (2015–2018) as compared with the early period (2011–2014). Symptom control and complication rate were equivalent between the two periods. Conclusions Anti-reflux surgery was effective with > 90% of typical symptom resolution and posed a comparable postoperative complication rate with those in Western studies with mid-term to long-term follow-up. This result supports the feasibility and safety of anti-reflux surgery as a treatment for GERD in the Korean population.
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Park, Sungsoo
안암병원 (Department of Foregut Surgery, Anam Hospital)
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