Esophageal Motility Outcome after Nissen Fundoplication: A Systematic Review and Meta-Analysis
Notice bibliographique
Résumé
Background: Gastroesophageal reflux disease (GERD) is a very prevalent disease. The Montreal consensus conference in 2006 defined GERD as "a condition which develops when the re-flux of gastric contents causes troublesome symptoms and/or complications". The pathophysiology of GERD is multifactori-al and complex but revolves around an incompetent esophago-gastric junction (EGJ) as an anti-reflux barrier, in the form of transient lower esophageal sphincter relaxations (TLESR) and/ or a hypotensive EGJ. Aim of Study: To evaluate the efficacy of laparoscopic surgeries with regard to esophageal motility and determine a clear indication for these interventions. Additionally, we will compare between preoperative and postoperative manometer results. Patients and Methods: This systematic review and me-ta-analysis was conducted by careful following of the Cochrane handbook for systematic reviews interventions and the results were described according to the Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) statement. The following electronic databases were searched till 2022: Pu-bMed, Medline, Embase, Cochrane Library, Springer link, da-tabases. A manual search was also performed to identify trials in the reference lists of the articles acquired. A search strategy using disease-specific terms (e.g., gastro-esophageal reflux dis-ease), management-specific terms (e.g., laparoscopic antireflux fundoplication), and terms related to surgical procedures (Nis-sen) were adopted. Results: The forest plot meta-analysis shows that Nissen fundoplication significantly reduce the maximum diameter of the EGJ. Also it reduces significantly the cross-section area (CSA) at the EGJ, which means successful fundoplication that permit less refluxate through the EGJ. Also Distensibility in-dex (DI) which can be calculated by dividing the cross-section area of the EGJ (CSA) by the infra-bag pressure at the EGJ. It was found that the distensibility index decreased significantly after Nissen fundoplication than that before fundoplication The decrease of the Distensibility index means more tight fundopli-cation that controlling reflux. Conclusion: This meta-analysis concluded that Nissen fun-doplication increase significantly the LESP which control most of the reflux symptoms as it decreases significantly the regur-gitation and heart burn symptoms. Also, it found that it signifi-cantly decreases the use of proton pump inhibitors and improve life mode of the patient. But it does not significantly change the dysphagia symptoms especially in the early postoperative period. This study promotes much research on the EndoFLIP maneuver during the operation just in the time before insuffla-tion and after performing the wrap as this Endo FLIP assists mostly adjusting the tightness of the wrap.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,006 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,010 | 0,008 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,004 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».