Assessment of diaphragmatic stressors as risk factors for symptomatic failure of laparoscopic nissen fundoplication

Atif Iqbal, Ganesh V. Kakarlapudi, Ziad T. Awad, Gleb Haynatzki, Kiran K. Turaga, Anouki Karu, Katie Fritz, Mumnoon Haider, Sumeet K. Mittal, Charles Filipi

Research output: Contribution to journalArticle

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Abstract

An important limitation of antireflux surgery is a 5%-10% failure rate. We investigated the correlation between various diaphragm stressors and failure of antireflux surgery. Forty-one study cases who underwent a reoperative antireflux operation from 1997 to 2001 and 50 control patients who had undergone a successful laparoscopic Nissen fundoplication during the same period without clinical or symptomatic evidence of failure were randomly selected for comparison. A retrospective analysis was conducted utilizing a standardized diaphragm stressor questionnaire, addressing the period between the primary and secondary operation. Stressors considered in the study included height, body mass index (BMI), postoperative gagging, vomiting, weight lifting (greater than 100 pounds), coughing, hiccuping, motion sickness, retching, belching, antidepressant use, smoking, preoperative grade of esophagitis, size of hiatal hernia, lower esophageal sphincter pressure, esophageal body pressures, and preoperative response to proton pump inhibitors. Of the potential stressors investigated, the following were significantly associated with surgical failure after adjusting for other variables through multivariate analysis: gagging (P = 0.005), belching (P = 0.02), and hernia size greater than 3 cm (P = 0.04; Table 1). Other potential risk factors show trends as obvious in Fig. 2. Vomiting was significant (P = 0.01) in the earlier models but lost significance when logistic regression was applied. Patients with postoperative gagging and an intraoperative hiatal hernia (greater than 3 cm) have a poorer outcome, whereas patients with postoperative belching have a better long-term outcome.

Original languageEnglish
Pages (from-to)12-21
Number of pages10
JournalJournal of Gastrointestinal Surgery
Volume10
Issue number1
DOIs
StatePublished - Jan 1 2006

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Gagging
Eructation
Fundoplication
Hiatal Hernia
Diaphragm
Weight Lifting
Motion Sickness
Pressure
Postoperative Nausea and Vomiting
Lower Esophageal Sphincter
Esophagitis
Proton Pump Inhibitors
Hernia
Antidepressive Agents
Vomiting
Body Mass Index
Multivariate Analysis
Logistic Models
Smoking

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Assessment of diaphragmatic stressors as risk factors for symptomatic failure of laparoscopic nissen fundoplication. / Iqbal, Atif; Kakarlapudi, Ganesh V.; Awad, Ziad T.; Haynatzki, Gleb; Turaga, Kiran K.; Karu, Anouki; Fritz, Katie; Haider, Mumnoon; Mittal, Sumeet K.; Filipi, Charles.

In: Journal of Gastrointestinal Surgery, Vol. 10, No. 1, 01.01.2006, p. 12-21.

Research output: Contribution to journalArticle

Iqbal, A, Kakarlapudi, GV, Awad, ZT, Haynatzki, G, Turaga, KK, Karu, A, Fritz, K, Haider, M, Mittal, SK & Filipi, C 2006, 'Assessment of diaphragmatic stressors as risk factors for symptomatic failure of laparoscopic nissen fundoplication', Journal of Gastrointestinal Surgery, vol. 10, no. 1, pp. 12-21. https://doi.org/10.1016/j.gassur.2005.10.011
Iqbal, Atif ; Kakarlapudi, Ganesh V. ; Awad, Ziad T. ; Haynatzki, Gleb ; Turaga, Kiran K. ; Karu, Anouki ; Fritz, Katie ; Haider, Mumnoon ; Mittal, Sumeet K. ; Filipi, Charles. / Assessment of diaphragmatic stressors as risk factors for symptomatic failure of laparoscopic nissen fundoplication. In: Journal of Gastrointestinal Surgery. 2006 ; Vol. 10, No. 1. pp. 12-21.
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