Laparoscopic Total Fundoplication for Duodenogastroesophageal Reflux

NCT ID: NCT01741441

Last Updated: 2012-12-05

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

188 participants

Study Classification

OBSERVATIONAL

Study Start Date

2002-06-30

Study Completion Date

2012-06-30

Brief Summary

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After laparoscopic total fundoplication (LTF) 12-15% of patients have persistent reflux symptoms and 20-25% develop gas-related symptoms. Reflux symptoms, gas bloating and inability to belch occurring after surgery have been associated with mixed (acid and weakly acid) (MR) or weakly acidic reflux (WAR). To date, few studies have evaluated functional outcome after LTF in patients with MR or WAR, with the majority reporting only short-term results.

It has been shown that delayed gastric emptying (DGE) might also be an important factor for abdominal distension and adverse outcome after LTF.9,10 However, the correlation between poor long-term outcome after LTF and DGE is controversial. In addition, the effect of DGE in patients with MR or WAR is poorly investigated.

Detailed Description

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In the last years the study of gastro-oesophageal reflux has been revolutionized by the development of combined 24-h esophageal pH and multichannel intraluminal impedance (MII) monitoring.

Combined esophageal MII and pH-monitoring allow for the timed correlation of esophageal pH changes with reflux events and achieve high sensitivity for the detection of acid (pH \<4), weakly acidic (pH 4-7) and weakly alkaline (pH \>7) reflux episodes. Use of this technology is bringing into focus the potential role of weakly acidic and weakly alkaline reflux in symptoms that persist despite acid suppressive therapy or anti-reflux surgery.

Conditions

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Duodenogastric Reflux

Keywords

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Duodenogastroesophageal reflux Weakly acidic reflux Gastric emptying Laparoscopic fundoplication

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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WAR and MR patients

Consecutive patients with MR and WAR selected for laparoscopic total fundoplication (LTF) were included in a prospective clinical study. Gastroesophageal function was assessed by clinical validated questionnaires, upper endoscopy, esophageal manometry and 24-h impedance pH monitoring before and 12 and 60 months after LTF. Gastric scintigraphy was preoperatively performed in all patients.

laparoscopic total fundoplication

Intervention Type PROCEDURE

LTF was performed using a standard five-trocar technique in all cases and carried out by two expert surgeons who had previously performed more than 50 laparoscopic fundoplications. A floppy 360° total fundoplication of 2-2,5 cm was constructed after full esophageal mobilization and posterior crural repair with nonabsorbable sutures.

Interventions

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laparoscopic total fundoplication

LTF was performed using a standard five-trocar technique in all cases and carried out by two expert surgeons who had previously performed more than 50 laparoscopic fundoplications. A floppy 360° total fundoplication of 2-2,5 cm was constructed after full esophageal mobilization and posterior crural repair with nonabsorbable sutures.

Intervention Type PROCEDURE

Other Intervention Names

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Laparoscopic Nissen fundoplication Laparoscopic 360° degree fundoplication

Eligibility Criteria

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Inclusion Criteria

\- The study population consisted of consecutive patients with weakly acidic gastroesophageal reflux (GER) confirmed by 24 hour pH and impedance monitoring and eligible for laparoscopic antireflux surgery (LARS).
Minimum Eligible Age

14 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Turin, Italy

OTHER

Sponsor Role lead

Responsible Party

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Fabrizio Rebecchi

Medical Doctor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Fabrizio Rebecchi, MD

Role: PRINCIPAL_INVESTIGATOR

University of Turin, Italy

Mario Morino, MD

Role: STUDY_DIRECTOR

University of Turin, Italy

Marco Ettore Allaix, MD

Role: STUDY_CHAIR

University of Turin, Italy

Claudio Giaccone, MD

Role: STUDY_CHAIR

University of Turin, Italy

Locations

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Digestive, Colorectal, Oncologic and Minimally Invasive Surgery, Department of Surgical Sciences

Turin, , Italy

Site Status

Countries

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Italy

References

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Broeders JA, Mauritz FA, Ahmed Ali U, Draaisma WA, Ruurda JP, Gooszen HG, Smout AJ, Broeders IA, Hazebroek EJ. Systematic review and meta-analysis of laparoscopic Nissen (posterior total) versus Toupet (posterior partial) fundoplication for gastro-oesophageal reflux disease. Br J Surg. 2010 Sep;97(9):1318-30. doi: 10.1002/bjs.7174.

Reference Type BACKGROUND
PMID: 20641062 (View on PubMed)

Broeders JA, Bredenoord AJ, Hazebroek EJ, Broeders IA, Gooszen HG, Smout AJ. Reflux and belching after 270 degree versus 360 degree laparoscopic posterior fundoplication. Ann Surg. 2012 Jan;255(1):59-65. doi: 10.1097/SLA.0b013e31823899f8.

Reference Type BACKGROUND
PMID: 22167002 (View on PubMed)

Broeders JA, Bredenoord AJ, Hazebroek EJ, Broeders IA, Gooszen HG, Smout AJ. Effects of anti-reflux surgery on weakly acidic reflux and belching. Gut. 2011 Apr;60(4):435-41. doi: 10.1136/gut.2010.224824. Epub 2010 Dec 30.

Reference Type BACKGROUND
PMID: 21193452 (View on PubMed)

Namasivayam V, Arora AS, Murray JA. Weakly acidic reflux. Dis Esophagus. 2011 Jan;24(1):56-62. doi: 10.1111/j.1442-2050.2010.01100.x.

Reference Type BACKGROUND
PMID: 20659138 (View on PubMed)

Frazzoni M, Conigliaro R, Melotti G. Reflux parameters as modified by laparoscopic fundoplication in 40 patients with heartburn/regurgitation persisting despite PPI therapy: a study using impedance-pH monitoring. Dig Dis Sci. 2011 Apr;56(4):1099-106. doi: 10.1007/s10620-010-1381-4. Epub 2010 Aug 25.

Reference Type BACKGROUND
PMID: 20737211 (View on PubMed)

Frazzoni M, Conigliaro R, Melotti G. Weakly acidic refluxes have a major role in the pathogenesis of proton pump inhibitor-resistant reflux oesophagitis. Aliment Pharmacol Ther. 2011 Mar;33(5):601-6. doi: 10.1111/j.1365-2036.2010.04550.x. Epub 2010 Dec 29.

Reference Type BACKGROUND
PMID: 21198705 (View on PubMed)

Castell DO, Murray JA, Tutuian R, Orlando RC, Arnold R. Review article: the pathophysiology of gastro-oesophageal reflux disease - oesophageal manifestations. Aliment Pharmacol Ther. 2004 Dec;20 Suppl 9:14-25. doi: 10.1111/j.1365-2036.2004.02238.x.

Reference Type BACKGROUND
PMID: 15527461 (View on PubMed)

Boeckxstaens GE. Review article: the pathophysiology of gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2007 Jul 15;26(2):149-60. doi: 10.1111/j.1365-2036.2007.03372.x.

Reference Type BACKGROUND
PMID: 17593062 (View on PubMed)

Nakos A, Kouklakis G, Pitiakoudis M, Zezos P, Efraimidou E, Giatromanolaki A, Polychronidis A, Liratzopoulos N, Sivridis E, Simopoulos K. The histological and immunohistochemical aspects of bile reflux in patients with gastroesophageal reflux disease. Gastroenterol Res Pract. 2011;2011:905872. doi: 10.1155/2011/905872. Epub 2011 Jul 24.

Reference Type BACKGROUND
PMID: 21822428 (View on PubMed)

Rebecchi F, Giaccone C, Farinella E, Campaci R, Morino M. Randomized controlled trial of laparoscopic Heller myotomy plus Dor fundoplication versus Nissen fundoplication for achalasia: long-term results. Ann Surg. 2008 Dec;248(6):1023-30. doi: 10.1097/SLA.0b013e318190a776.

Reference Type BACKGROUND
PMID: 19092347 (View on PubMed)

Morino M, Giaccone C, Pellegrino L, Rebecchi F. Laparoscopic management of giant hiatal hernia: factors influencing long-term outcome. Surg Endosc. 2006 Jul;20(7):1011-6. doi: 10.1007/s00464-005-0550-6. Epub 2006 Jun 8.

Reference Type BACKGROUND
PMID: 16763927 (View on PubMed)

Rebecchi F, Allaix ME, Giaccone C, Morino M. Gastric emptying as a prognostic factor for long-term results of total laparoscopic fundoplication for weakly acidic or mixed reflux. Ann Surg. 2013 Nov;258(5):831-6; discussion 836-7. doi: 10.1097/SLA.0b013e3182a6882a.

Reference Type DERIVED
PMID: 24045453 (View on PubMed)

Other Identifiers

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LTF-2002-TO

Identifier Type: -

Identifier Source: org_study_id