Trends in laparoscopic anti-reflux surgery: a Korea nationwide study
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Trends in laparoscopic anti‑reflux surgery: a Korea nationwide study Min Seo Kim1 · Youjin Oh1 · Jun‑Hyun Lee2 · Joong‑Min Park3 · Jin‑Jo Kim2 · Kyo Young Song2 · Seung Wan Ryu5 · Kyung Won Seo6 · Hyoung‑Il Kim7 · Dong Jin Kim2 · Sungsoo Park8 · Sang‑Uk Han4 · Korean Anti-reflux Surgery Study (KARS) group Received: 13 March 2020 / Accepted: 17 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
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 5 Duration of PPI treatment, months (n = 280) 12 PPI response (n = 273) None or poor Fair Good to excellent GERD symptom Typical symptom (n = 300) Atypical symptom (n = 293) Mixed symptom (n = 288) Los Angeles grade of esophagitis (n = 258) Minimal or no esophagitis A B C D Hiatal hernia (n = 269) No hiatal hernia Type 1 Type 2 Type 3 Complication on endoscopy (n = 247) None Barrett esophagus Ulcer Stricture pH monitoring study (n = 125) DeMeester score Pathologic acid reflux (DeMeester score > 14.7) Esophageal manometry (n = 152) LES pressure (mmHg)
49.3 ± 18.0 174 (55.1)/142 (44.9) 23.0 ± 3.5 4 (1.5–10)* 42 (14.5) 109 (37.6) 139 (47.9) 12 (5–48)* 73 (26.1) 39 (13.9) 168 (60.0) 97 (35.5) 95 (34.8) 81 (29.7) 275 (91.7) 208 (71.0) 191 (66.3) 137 (53.1) 86 (33.3) 22 (8.5) 11 (4.3) 2 (0.8) 145 (53.9) 115 (42.8) 2 (0.7) 7 (2.6) 228 (92.3) 13 (5.3) 5 (2.0) 1 (0.4) 23.5 ± 47.4 (2.2–29.3) 50 (40)
22.4 ± 13.5 (13.4–30.0)
Values were presented as mean ± SD (range) or number (%) GERD
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