Abstract
Introduction
Gastroesophageal reflux disease (GERD) is a chronic condition of alimentary tract, that can lead to major complications. Surgical treatment of patients with GERD and concomitant hiatal hernia is commonly employed when pharmacotherapy is not effective. Available surgical treatment options consist of Nissen fundoplication, Toupet fundoplication, and newer procedures such as LINX system or RefluxStop™.
Aim
The aim of this review is to present four surgical treatment methods of GERD in patients with concomitant hiatal hernia. The analysis consists of the assessment of reduction of GERD symptoms, improvement in the quality of life and postoperative complication indicators.
Materials and methods
Analysis was conducted using data from clinical trials, meta-analyses and systematic reviews, concerning patients with GERD concomitant with hiatal hernia, who underwent one of four treatment methods: Nissen fundoplication, Toupet fundoplication, LINX system or RefluxStop™. Included results consist of reflux disease symptoms control, heartburn relief, and safety of procedures.
Results
The analysis showed that all four surgical treatment methods effectively relieve symptoms of GERD, but they differ among factors such as: level of invasiveness, postoperative complications and long term effectiveness. Nissen and Toupet fundoplications, more traditional approaches, offer solid results in reflux control, but may be linked to a greater risk of complications, such as dysphagia or gas-bloat syndrome. Methods such as LINX and RefluxStop™ are less invasive, and their clinical results show lesser risk of complications, which may be a significant benefit for the patients.
Conclusions
Newer treatment methods, such as LINX and RefluxStop™, may offer an effective alternative to traditional fundoplication procedures, especially in patients with smaller hiatal hernias. Choice of an optimal treatment method should be tailored to the individual patients characteristics and to the severity of the disease.