Evidence map›Paper›PMID 31214803›Full record

ArticleSurgical endoscopy2020

The relationship between gastroesophageal junction integrity and symptomatic fundoplication outcomes.

Brexton Turner, Melissa Helm, Emily Hetzel, Max Schumm, Jon C Gould

Abstract readComparative Study
PubMed Publisher
In one paragraph

Article in Surgical endoscopy, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
0.3field-weighted citation impact, top 38% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it, 6 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Laparoscopic posterior cruroplasty: a patient tailored approach.Hernia : the journal of hernias and abdominal wall surgery · 2022
    Article
  4. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 1 institution in 1 country.

Brexton TurnerDivision of General Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd, HUB 6th Floor, Milwaukee, WI, 53226, USA.
Melissa HelmDivision of General Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd, HUB 6th Floor, Milwaukee, WI, 53226, USA.
Emily HetzelDivision of General Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd, HUB 6th Floor, Milwaukee, WI, 53226, USA.
Max SchummDivision of General Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd, HUB 6th Floor, Milwaukee, WI, 53226, USA.
Jon C GouldDivision of General Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd, HUB 6th Floor, Milwaukee, WI, 53226, USA. jgould@mcw.edu.ORCID 0000-0002-7038-6995
Medical College of Wisconsin · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe majority of patients who undergo a laparoscopic fundoplication for gastroesophageal reflux disease (GERD) have a structural (hiatal hernia, shortened lower esophageal sphincter [LES]) or functional (weak LES) defect of the gastroesophageal junction (GEJ). We hypothesized that the symptomatic outcomes of fundoplication in patients with a competent GEJ prior to surgery are inferior to those with an incompetent GEJ.

methodsThis is a retrospective review of prospectively maintained data on subjects who underwent primary laparoscopic fundoplication (Nissen or Toupet) for medically refractory and confirmed GERD. Three esophageal manometry variables were used to determine GEJ competency: (1) hiatal hernia (normal = no hernia), (2) total lower esophageal sphincter length (normal ≥ 2.43 cm), and (3) lower esophageal sphincter pressure (normal = 15.0-43.7 mmHg). Patients in the competent group had normal values for all 3 variables. Symptomatic outcomes were assessed with the GERD Health-Related Quality of Life (HRQL) survey administered pre- and postoperatively, and then compared both intragroup, intergroup, and by procedure.

resultsA total of 78 patients met inclusion criteria-17 competent GEJ and 61 incompetent GEJ patients. GERD-HRQL scores improved in the incompetent cohort at all intervals out to 2 years postoperatively. GERD-HRQL improved in the competent cohort at 2 months, with no difference at 6 months or 2 years postoperatively compared to preoperative scores. Competent GEJ patients receiving a Nissen fundoplication had a higher rate of additional procedures (endoscopy with or without dilation, pH studies) following surgery to address recurrent or persistent GERD symptoms compared to Toupet.

conclusionsGERD patients with a competent GEJ report a lower GERD-HRQL with more frequent and severe reflux symptoms up to 2 years post-fundoplication. Competent GEJ patients receiving a Nissen fundoplication are more likely to have additional procedures to address symptoms following surgery. Surgeons should approach patients with a competent GEJ and medically refractory GERD with caution.

Indexed as

Quality of LifeAdultEsophageal Sphincter, LowerEsophagogastric JunctionFemaleFundoplicationGastroesophageal RefluxHernia, HiatalHumansLaparoscopyMaleManometryMiddle AgedPostoperative PeriodPreoperative PeriodProspective StudiesFundoplicationGastroesophageal junctionGastroesophageal reflux diseaseHiatal herniaLower esophageal sphincterManometry

Identifiers

PMID31214803
OpenAlexW2952647721

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.