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123
Surgical and Therapeutic
Innovations
Santiago Horgan
Karl-Hermann Fuchs
Editors
Management of
Gastroesophageal
Reux Disease
Management of Gastroesophageal
Reux Disease
Santiago Horgan • Karl-Hermann Fuchs
Editors
Management of
Gastroesophageal
Reux Disease
Surgical andTherapeutic Innovations
Editors
Santiago Horgan
University of California, San Diego
Center for the Future of Surgery
La Jolla, CA
USA
Karl-Hermann Fuchs
University of California, San Diego
Center for the Future of Surgery
La Jolla, CA
USA
ISBN 978-3-030-48008-0 ISBN 978-3-030-48009-7 (eBook)
https://doi.org/10.1007/978-3-030-48009-7
© Springer Nature Switzerland AG 2020
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of
the material is concerned, specically the rights of translation, reprinting, reuse of illustrations, recita-
tion, broadcasting, reproduction on microlms or in any other physical way, and transmission or infor-
mation storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar
methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publica-
tion does not imply, even in the absence of a specic statement, that such names are exempt from the
relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, expressed or implied, with respect to the material contained herein or for any
errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional
claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
v
Foreword
The diagnosis and management of Gastroesophageal Reux Disease (GERD) has
changed substantially over the course of the past decades. GERD is a highly preva-
lent disease in western industrial countries and accounts for a large part of health-
care budgets in these countries. As a consequence, many doctors, technicians,
nursing staff, and other caretakers are involved in diagnosis and therapy of
GERD.New developments and insights have shown a multifactorial pathophysio-
logic background, emerging new diagnostic technologies, and a variety of therapeu-
tic options. Each of these requires signicant expertise to adequately diagnose and
respond to a patient’s needs. This book provides an overview on the new aspects of
GERD for all involved specialties and disciplines.
The close association with related diseases such as functional dyspepsia, gastro-
intestinal motility disorders, and somatoform tendencies creates a diagnostic chal-
lenge. Detailed knowledge is therefore required to manage GERD, especially as the
diagnostic modalities combined with innovations in endoscopic and surgical treat-
ment are developing/emerging quickly. This work provides a comprehensive state-
of- the art overview in the eld of GERD, as well as a current insight into new
algorithms for diagnosis and treatments (endoscopic and surgical). The book is a
valuable as resource of knowledge for clinicians, surgeons, nurses, technicians, stu-
dents, and researchers with an interest in esophageal and upper gastrointestinal
disease.
We want to thank all authors and co-authors for their excellent work and dedica-
tion to make this project possible. We also want to express our gratitude to all
involved at Springer publishing company for their assistance and professionalism
through the publishing process.
Finally, we would like to express our gratitude for the outstanding, supportive
environment at UC San Diego that made this possible. We are extremely excited and
grateful for this project.
La Jolla, CA, USA SantiagoHorgan
Karl-HermannFuchs
vii
Contents
1 Definition and Pathophysiology of Gastroesophageal Reflux
Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Karl-Hermann Fuchs
2 Symptom Spectrum in Gastroesophageal Reflux Disease . . . . . . . . . . . 19
Ryan C. Broderick and Karl-Hermann Fuchs
3 Diagnostic Investigations in GERD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
David C. Kunkel
4 Medical Therapy of GERD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Karima Farrag and Jürgen Stein
5 Indications for Interventional and Surgical Therapy in GERD . . . . . . 47
Hans Friedrich Fuchs
6 Endoscopic Therapy for GERD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Andreas Wannhoff and Karel Caca
7 Surgical Management of Gastroesophageal Reflux Disease . . . . . . . . . 69
Sean M. Flynn, Ryan C. Broderick, and Santiago Horgan
8 The Nissen Fundoplication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Karl-Hermann Fuchs, Wolfram Breithaupt, and Gabor Varga
9 The Posterior Partial Toupet Hemifundoplication . . . . . . . . . . . . . . . . 95
Wolfram Breithaupt and Gabor Varga
10 Controversies Regarding Mesh Implantation for Hiatal
Reinforcement in GERD and Hiatal Hernia Surgery . . . . . . . . . . . . . . 103
Ryan C. Broderick
11 Robotic Hiatal Hernia Repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Joslin N. Cheverie, Ryan C. Broderick, Robert F. Cubas,
and Santiago Horgan
12 Management of the Short Esophagus in GERD. . . . . . . . . . . . . . . . . . . 139
Steven R. DeMeester
viii
13 Overview and Management of Paraesophageal Hernias . . . . . . . . . . . . 149
Arielle Lee, Kai Neki, José Bezerra Câmara Neto,
and Karl-Hermann Fuchs
14 Gastroesophageal Reflux Disease in Sleeve Gastrectomy:
Pathophysiology and Available Treatments . . . . . . . . . . . . . . . . . . . . . . 167
Sean M. Flynn and Ryan C. Broderick
15 Magnetic Sphincter Augmentation for the Treatment
of Gastroesophageal Reflux Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
Ryan C. Broderick and Santiago Horgan
16 Endostim Implantation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
Edy Soffer
17 Causes of Failures After Antireflux Surgery and Indication,
Technique and Results of Laparoscopic Redo- Antireflux
Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
Karl-Hermann Fuchs
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
Contents
ix
Contributors
Wolfram Breithaupt Agaplesion Markus Krankenhaus, Department of General
and GI-Surgery, Frankfurt am Main, Germany
Ryan C. Broderick Division of Minimally Invasive Surgery, Department of
Surgery, University of California San Diego, La Jolla, CA, USA
Department of Surgery, Center for the Future of Surgery, University of California
San Diego, La Jolla, CA, USA
Karel Caca Department of Gastroenterology, Hospital Ludwigsburg,
Ludwigsburg, Germany
Joslin N. Cheverie Division of Minimally Invasive Surgery, Department of
Surgery, University of California San Diego Medical Center, La Jolla, CA, USA
RobertF.Cubas Division of Minimally Invasive Surgery, Department of Surgery,
University of California San Diego Medical Center, La Jolla, CA, USA
Steven R. DeMeester Thoracic and Foregut Surgery, The Oregon Clinic,
Portland, OR, USA
Karima Farrag Department of Gastroenterology, Krankenhaus Sachsenhausen,
Frankfurt am Main, Germany
SeanM.Flynn
Division of Minimally Invasive Surgery, Department of Surgery,
University of California San Diego, La Jolla, CA, USA
Karl-HermannFuchs
University of California San Diego, Center for the Future
of Surgery, La Jolla, CA, USA
HansFriedrichFuchs Department of General, GI- and Tumor Surgery, University
of Cologne, Cologne, Germany
SantiagoHorgan Division of Minimally Invasive Surgery, Department of Surgery,
University of California San Diego, La Jolla, CA, USA
DavidC. Kunkel University of California San Diego, Department of Medicine
Gastroenterology, La Jolla, CA, USA
ArielleLee University of California San Diego, Center for the Future of Surgery,
La Jolla, CA, USA
x
KaiNeki University of California San Diego, Center for the Future of Surgery, La
Jolla, CA, USA
JoséBezerra Câmara Neto University of California San Diego, Center for the
Future of Surgery, La Jolla, CA, USA
Edy Soffer Department of Medicine, Keck School of Medicine, University of
Southern California, Los Angeles, CA, USA
Jürgen Stein
Department of Gastroenterology, Krankenhaus Sachsenhausen,
Frankfurt am Main, Germany
Gabor Varga Agaplesion Markus Krankenhaus, Department of General and
GI-Surgery, Frankfurt am Main, Germany
Andreas Wannhoff Department of Gastroenterology, Hospital Ludwigsburg,
Ludwigsburg, Germany
Contributors
1
© Springer Nature Switzerland AG 2020
S. Horgan, K.-H. Fuchs (eds.), Management of Gastroesophageal Reux Disease,
https://doi.org/10.1007/978-3-030-48009-7_1
Definition andPathophysiology
ofGastroesophageal Reflux Disease
Karl-HermannFuchs
Introduction andDefinition
Gastroesophageal reux disease (GERD) is a multifactorial determined disease
with a high prevalence in Western industrial populations [1–4]. Several attempts
have been made in the past to dene this disease and at the same time create a deni-
tion, which can clinically be used for decision-making [5, 6]. The problem with a
denition is the complex pathophysiologic process on one side and the necessity to
have a feasible solution for clinical practice. The Montréal classication and deni-
tion for GERD is accepted worldwide; however, a denition using symptoms has its
limitations and has led to some criticism in several guidelines [1–4].
Symptoms are quite unreliable and, therefore, a denition based on symptoms
could be not precise enough for some applications [7, 8]. Symptoms of GERD have
a large overlap with other functional disorders of the upper GI tract and, therefore,
there is lack of precision. On the other hand, a denition of a disease should be help-
ful for diagnostic and therapeutic decision-making, which in the case of GERD may
lead to controversies.
As a consequence, GERD should be best dened with clinical parameters, visi-
ble endoscopic damage, and functional quantitative assessment in order to be used
for therapeutic decisions [4, 5]. The latter sort of denition would respond to the
multifactorial character of the disease. Critics of such controversial thinking claim
that this would lead to a complex denition, which could hardly be applied in daily
practice. The European Association of Endoscopic Surgery has demonstrated in its
guidelines that the Montréal denition can be a basis for dening the disease but
must be expanded by objective criteria [3].
Gastroesophageal reux disease is present when a given person suffers from
troublesome symptoms by reux of gastric contents into the esophagus, and this
process can be objectied by diagnostic investigations such as endoscopic visible
K.-H. Fuchs (*)
University of California San Diego, Center for the Future of Surgery, La Jolla, CA, USA
1