Advertisement

Enhancing Clinical Outcomes Through Better Postoperative Management and Follow-Up

  • Lee L SwanstromEmail author
Chapter

Abstract

Better clinical outcomes are not just a matter of performing an indicated operative procedure well, but perhaps even more—a factor of appropriate patient selection, work-up, and pre-procedure education. This chapter adds another important factor—the need to longitudinally follow patients, measuring both objective and subjective outcomes in order to council patients, determine when re-intervention is indicated and to allow surgeons to alter and improve their technique based on their own results (continuous quality improvement).

Perhaps naturally, surgeons tend to focus on the technical aspects of procedures, and to some extent, the indications and preparations for the operation, rather than the care and follow-up of the patient. Fundoplication, however, is a functional repair of a chronic disease and, like other such surgeries (bariatric procedures and Crohn’s surgeries come to mind), it requires as much care and focus for the aftercare of the patient as is given to the preoperative evaluation and operative technique. In addition, continuous improvement of a surgeon’s outcomes in antireflux surgery comes from careful and objective surveillance of one’s results. In this chapter, we will discuss elements of postoperative care and follow-up that can affect the effectiveness of the fundoplication surgery.

Keywords

Fundoplication Postoperative Follow-up GERD Surgery Endoscopy Database Manometry pH testing Quality of life 

References

  1. 1.
    Makris KI, Cassera MA, Kastenmeier AS, Dunst CM, Swanström LL. Postoperative dysphagia is not predictive of long-term failure after laparoscopic antireflux surgery. Surg Endosc. 2011;26(2):451–7.CrossRefPubMedGoogle Scholar
  2. 2.
    Swanstrom LL, Wayne R. Spectrum of gastrointestinal symptoms after laparoscopic fundoplication. Am J Surg. 1994;167(5):538–41.CrossRefPubMedGoogle Scholar
  3. 3.
    Rantanen T, Kiljander T, Salminen P, Ranta A, Oksala N, Kellokumpu I. Reflux symptoms and side effects among patients with gastroesophageal reflux disease at baseline, during treatment with PPIs, and after Nissen fundoplication. World J Surg. 2013;37(6):1291–6. doi: 10.1007/s00268-013-1979-8.CrossRefPubMedGoogle Scholar
  4. 4.
    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;255(1):59–65.CrossRefPubMedGoogle Scholar
  5. 5.
    Lundell L. Surgical therapy of gastro-oesophageal reflux disease. Best Pract Res Clin Gastroenterol. 2010;24(6):947–59.CrossRefPubMedGoogle Scholar
  6. 6.
    Khajanchee YS, O’Rourke RW, Lockhart BA, Patterson EJ, Hansen PD, Swanstrom LL. Postoperative Symptoms and failure following antireflux surgery. Arch Surg. 2002;137(9):1008–14.CrossRefPubMedGoogle Scholar
  7. 7.
    Chan K, Liu G, Miller L, Ma C, Xu W, Schlachta CM, Darling G. Lack of correlation between a self-administered subjective GERD questionnaire and pathologic GERD diagnosed by 24-h esophageal pH monitoring. J Gastrointest Surg. 2010;14(3):427–36.CrossRefPubMedGoogle Scholar
  8. 8.
    Robinson B, Dunst CM, Cassera MA, Reavis KM, Sharata A, Swanström LL. 20 years later: laparoscopic fundoplication durability. Surg Endosc. 2015;29(9):2520–4.CrossRefPubMedGoogle Scholar
  9. 9.
    Kaji M, Fujiwara Y, Shiba M, Kohata Y, Yamagami H, Tanigawa T, Watanabe K, Watanabe T, Tominaga K, Arakawa T. Prevalence of overlaps between GERD, FD and IBS and impact on health-related quality of life. J Gastroenterol Hepatol. 2010;25(6):1151–6.CrossRefPubMedGoogle Scholar
  10. 10.
    Chan Y, Ching JY, Cheung CM, Tsoi KK, Polder-Verkiel S, Pang SH, Quan WL, Kee KM, Chan FK, Sung JJ, Wu JC. Development and validation of a disease-specific quality of life questionnaire for gastro-oesophageal reflux disease: the GERD-QOL questionnaire. Aliment Pharmacol Ther. 2010;31(3):452–60.CrossRefPubMedGoogle Scholar
  11. 11.
    Armstrong D, Mönnikes H, Bardhan KD, Stanghellini V. The construction of a new evaluative GERD questionnaire—methods and state of the art. Digestion. 2007;75 Suppl 1:17–24.CrossRefPubMedGoogle Scholar
  12. 12.
    Kwiatek MA, Kiebles JL, Taft TH, Pandolfino JE, Bové MJ, Kahrilas PJ, Keefer L. Esophageal symptoms questionnaire for the assessment of dysphagia, globus, and reflux symptoms: initial development and validation. Dis Esophagus. 2011;24(8):550–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Institut Hospitalo Universitaire—StrasbourgStrasbourgFrance
  2. 2.Division of GI/MISThe Oregon Clinic—Gastrointestinal & Minimally Invasive SurgeryPortlandUSA

Personalised recommendations