Impact of fundoplication for gastroesophageal reflux in the outcome of benign tracheal stenosis.

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  • Additional Information
    • Corporate Authors:
      Surgery of the Digestive Tract Group; Department of Gastroenterology, Discipline of Surgery of the Digestive Tract, Esophageal Function Laboratory, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo-SP, Sao Paulo, Brazil.
    • Source:
      Publisher: Mosby Country of Publication: United States NLM ID: 0376343 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1097-685X (Electronic) Linking ISSN: 00225223 NLM ISO Abbreviation: J Thorac Cardiovasc Surg Subsets: MEDLINE
    • Publication Information:
      Publication: St. Louis, MO : Mosby
      Original Publication: St. Louis.
    • Subject Terms:
      Laparoscopy*/adverse effects ; Watchful Waiting*; Fundoplication/*methods ; Gastroesophageal Reflux/*surgery ; Omeprazole/*therapeutic use ; Proton Pump Inhibitors/*therapeutic use ; Tracheal Stenosis/*surgery; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Fundoplication/adverse effects ; Gastroesophageal Reflux/complications ; Gastroesophageal Reflux/diagnosis ; Humans ; Male ; Middle Aged ; Omeprazole/adverse effects ; Proton Pump Inhibitors/adverse effects ; Retrospective Studies ; Time Factors ; Tracheal Stenosis/diagnosis ; Tracheal Stenosis/etiology ; Treatment Outcome ; Young Adult
    • Abstract:
      Objective: This study focuses on the impact of antireflux surgery in the outcome of tracheal stenosis.
      Methods: We performed a retrospective study including patients with benign tracheal stenosis who underwent esophageal manometry and dual-probe 24-hour ambulatory esophageal pH study. Patients with an abnormal pH study were managed with laparoscopic modified Nissen fundoplication or medically (omeprazole 80 mg/d, orally). Patients with normal pH study results were observed. After a 24-month follow-up, the outcome was considered satisfactory if tracheal stenosis could be managed by resection and there was no need for further dilatation or definitive decannulation. The management groups were compared using propensity score matching.
      Results: A total of 175 patients were included. Abnormal pH study results were found in 74 patients (42.3%), and 12.6% of patients had typical gastroesophageal reflux symptoms. Follow-up was completed in 124 patients (20 had fundoplication, 32 received omeprazole, and 72 were observed). After propensity score matching, the outcome of tracheal stenosis in the fundoplication group was similar to that of the observation group (odds ratio, 1; P = .99) and better than that of the omeprazole group (odds ratio, 5.31; P = .03). The observation (no gastroesophageal reflux) group had a better outcome of stenosis than those treated with omeprazole (odds ratio, 3.54; P = .02).
      Conclusions: The outcome of the airway stenosis was superior after laparoscopic fundoplication compared with medical treatment with omeprazole and was similar to the outcome of patients without gastroesophageal reflux. A prospective randomized trial is warranted.
      (Copyright © 2019 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
    • Comments:
      Comment in: J Thorac Cardiovasc Surg. 2019 Dec;158(6):1708-1709. (PMID: 31604634)
      Comment in: J Thorac Cardiovasc Surg. 2019 Dec;158(6):1707. (PMID: 31635863)
    • Contributed Indexing:
      Investigator: I Cecconello; A Nasi; RA Aissar Sallum
      Keywords: esophageal motility; esophageal pH study; fundoplication; gastroesophageal reflux; tracheal stenosis
    • Accession Number:
      0 (Proton Pump Inhibitors)
      KG60484QX9 (Omeprazole)
    • Publication Date:
      Date Created: 20191008 Date Completed: 20200302 Latest Revision: 20200302
    • Publication Date:
      20231215
    • Accession Number:
      10.1016/j.jtcvs.2019.07.111
    • Accession Number:
      31587887