Cost-effectiveness and budget impact of obesity surgery in patients with type 2 diabetes in three European countries(II).

Background: This study aimed to establish a payer-perspective cost-effectiveness and budget impact model of adjustable gastric banding (AGB) and gastric bypass (GBP) vs. conventional treatment (CT) in patients with a body mass index (BMI) > or = 35 kg x m(-2) and type 2 diabetes mellitus (T2DM) in Austria, Italy, and Spain.

Methods: A health economics model described in a previous publication was applied to resource utilization and cost data in AGB, GBP, and CT from Austria, Italy, and Spain in 2009.

Use of acid suppressive medications after laparoscopic antireflux surgery: prevalence and clinical indications.

Laparoscopic antireflux surgery (LARS) provides effective control of gastroesophageal reflux (GER) in more than 90% of patients. Despite this high success rate, some patients continue to consume acid suppressive medications after surgical intervention. In this study we evaluate the prevalence, clinical indications, and cause of use of acid reducing drugs in patients after LARS.

"Floppy" Nissen vs. Toupet laparoscopic fundoplication: quality of life assessment in a 5-year follow-up (part 2).

Background And Study Aims: Quality of life as an outcome variable has become an important measure in clinical research. This study is the second part of a prospective assessment of the quality of life outcome, in a 5-year follow-up of patients who underwent laparoscopic Nissen fundoplication or Toupet fundoplication. Data from a 1-year follow-up have been previously published (part I).

Comparison of methods for determining cricopharyngeal intrabolus pressure in normal patients as possible indicator for cricopharyngeal myotomy.

Objective: We sought to compare methods for determining intrabolus cricopharyngeal pressure as a possible indicator for cricopharyngeal myotomy.

Study Design: We determined multiple intrabolus pressures in the cricopharyngeal region of 20 normal volunteers, of whom 12 were 20 to 35 years old and 8 were older than 75 years. Data were collected using a commercially available manofluorography system and a 6-sensor unidirectional solid-state 2- x 4-mm catheter.

Outcome of laparoscopic antireflux surgery in patients with nonerosive reflux disease.

As many as 50% of patients with gastroesophageal reflux disease (GERD) have no endoscopic evidence of esophagitis (EGD negative). Laparoscopic antireflux surgery (LARS) provides effective symptomatic and endoscopic healing in patients with erosive GERD (EGD positive). The surgical outcome of patients undergoing LARS for EGD-negative GERD has not received wide attention.

Mid- and long-term quality of life assessments after laparoscopic fundoplication and refundoplication: a single unit review of more than 500 antireflux procedures.

Background: For the evaluation of surgical interventions, quality of life data are being increasingly used as an efficacy endpoint.

Aims: To evaluate impact of laparoscopic fundoplication and laparoscopic refundoplication on quality of life as well as on patient satisfaction with the procedure for at least 5 years after surgical intervention.

Patients: After more than 500 laparoscopic antireflux procedures, quality of life data have been prospectively reviewed and data compared with healthy individuals, untreated gastro-oesophageal reflux disease patients (n = 150) and successfully treated patients (n = B4) under adequate omeprazole therapy.

Failed antireflux surgery: surgical outcome of laparoscopic refundoplication in the elderly.

Background/aims: Antireflux surgery has a failure rate between 5 and 20%. Laparoscopic redo-surgery is feasible, but little is known about the surgical outcome in elderly patients. The aim of this prospective study was to evaluate early surgical experience and outcome, including quality of life, after laparoscopic refundoplication in patients older than 65 years.

Redo laparoscopic surgery for achalasia.

Background: Operative treatment of achalasia can fail in 10% to 15% of patients. No information is available on the outcome of laparoscopic reoperation for achalasia.

Methods: Data from patients undergoing redo surgery for achalasia were prospectively collected.

Austrian experiences of antireflux surgery.

Background: Antireflux surgery (ARS) is a well established treatment for GERD (gastroesophageal reflux disease). The present study gives an overview of experience in Austria regarding the frequency of open and laparoscopic ARS and how Austrian departments meet the requirements for surgery.

Methods: A questionnaire was sent to 115 surgical departments in Austria to evaluate in how many institutions antireflux surgery (open and/or laparoscopically) was performed since 1990, and which pre- and postoperative tests were obligatory, optional, or not performed.

Dysphagia and quality of life after laparoscopic Nissen fundoplication in patients with and without prosthetic reinforcement of the hiatal crura.

Background: Recurrent hiatal hernia with or without intrathoracic wrap migration ("slipping Nissen") is one of the most common complications after laparoscopic Nissen fundoplication (LNF). Therefore, we decided to reinforce the hiatal crura using a prosthetic mesh prosthesis in an attempt to reduce recurrent hiatal hernia.

Methods: The current nonrandomized study compares the surgical outcome, including quality of life data [Gastrointestinal Quality of Life Index (GIQLI)] and subjective degree of dysphagia, in a total of 200 patients with (n = 100) or without (n = 100) mesh prosthesis for a follow-up for at least 1 year.

Anxiety disorder after laparoscopic refundoplication as a cause of dysphagia.

Side effects of laparoscopic antireflux surgery doubtless have a negative effect on patients' satisfaction with surgical outcome and quality of life. Until now, side effects of laparoscopic antireflux surgery such as dysphagia have not been reported as associated with the origin of psychiatric disorders. We report the case of a 71-year-old man who underwent laparoscopic refundoplication because of a "slipping" Nissen 2 years after primary intervention.

Safety and long-term outcome of laparoscopic antireflux surgery in patients in their eighties and older.

Background: The elderly have more severe reflux disease and paraesophageal hernias than younger patients, leading to a high failure rate of medical therapy. Laparoscopic antireflux surgery has an overall mortality of 0.1% and a low morbidity, making it a safe and beneficial procedure for the elderly.

[Psycho-physiological aspects of gastroesophageal reflux disease].

It is well known that there is an interaction between physiological and psychological aspects of gastrointestinal diseases, also in esophageal symptoms. Based on this bio-psycho-social interaction, several multidisciplinary concepts of interventions in gastrointestinal disorders have been evaluated. The role of psychological factors in gastroesophageal reflux disease (GERD) is really unknown.

Comorbidity of aerophagia in GERD patients: outcome of laparoscopic antireflux surgery.

Background: While there is evidence that physiological data correlate poorly with quality-of-life data or patient-perceived symptom severity, most outcome studies of antireflux surgery still refer physiologic criteria. The aim of this prospective study was to establish whether concomitant aerophagia in GERD (gastroesophageal reflux disease) patients might influence the surgical outcome of laparoscopic 'floppy' Nissen fundoplication.

Methods: A total of 112 patients were divided into 2 subgroups: group 1 comprising GERD patients without aerophagia (n = 94; 84%); group 2 of GERD patients with concomitant aerophagia (n = 28; 16%).

Dilation after fundoplication: timing, frequency, indications, and outcome.

Background: Dysphagia frequently develops shortly after fundoplication but is usually self-limited. This is an evaluation of the timing, frequency, indications, and outcome of dilation after fundoplication.

Methods: Two hundred thirty-three consecutive patients who underwent fundoplication were included.

Laparoscopic antireflux surgery in gastro-oesophageal reflux disease patients with concomitant anxiety disorders.

Background: Several psychological factors are known to affect the subjective outcome, such as quality of life, after laparoscopic antireflux surgery.

Aim: To evaluate: a. outcome of laparoscopic antireflux surgery in gastro-oesophageal reflux disease patients with concomitant anxiety disorders, b.

[Outcome after laparoscopic antireflux surgery: fundoplication and re-fundoplication in the elderly].

Purpose: Treatment of gastroesophageal reflux disease (GERD) in the elderly follows the same principles as for any adult patient. The indication for laparoscopic antireflux surgery (LARS) often depends on the age of the patient. The aim of this prospective study was to evaluate the surgical outcome including quality of life after LARS and laparoscopic "redo-surgery" in patients older than 65 years.

Psychological intervention influences the outcome of laparoscopic antireflux surgery in patients with stress-related symptoms of gastroesophageal reflux disease.

Background: Psychological aspects such as stress, emotions, illness behaviour or personality are known to affect the severity of symptoms of gastroesophageal reflux disease (GERD) and can influence medical outcome in some patients. The aim of the present study was to evaluate the efficacy of psychological intervention within routine surgical care on the surgical outcome of laparoscopic antireflux surgery (LARS) in patients with stress-related GERD symptoms during a 1-year follow-up.

Methods: Out of a sample of 196 consecutive patients who required LARS (Nissen fundoplication), a group of 89 (45%) believed that stress was a factor in the cause of their symptoms (stress-related versus stress-unrelated GERD patients).

Role of axillary node dissection in patients with T1a and T1b breast cancer: Mayo Clinic experience.

Hypothesis: The incidence of nodal positivity in patients with early breast cancer is low, and axillary lymph node dissection may not be justified in all such patients.

Design: Retrospective case series.

Setting: Tertiary institution.

Five- to eight-year outcome of the first laparoscopic Nissen fundoplications.

The operative mortality and morbidity of laparoscopic fundoplication are lower than for the open procedure. Questions have been raised regarding its long-term durability. One hundred seventy-one patients who had undergone laparoscopic Nissen fundoplication at least 5 years previously answered a questionnaire.

Quality of life and surgical outcome after laparoscopic antireflux surgery in the elderly gastroesophageal reflux disease patient.

Background: Generally, treatment of gastroesophageal reflux disease (GERD) in the elderly follows the same principles as for any adult patient. Currently laparoscopic antireflux surgery (LARS) has not been clearly established in the elderly patient. The aim of this prospective study was to evaluate the surgical outcome including quality of life after LARS in patients older than 65 years.

Rationale for surgical therapy of Barrett esophagus.

Barrett esophagus has malignant potential and seems to be an acquired abnormality. It is associated with chronic gastroesophageal reflux disease and represents its severest form. The literature comparing medical treatment with antireflux surgery was reviewed.

[Quality of life and subjective evaluation of outcome quality 3 years after laparoscopic antireflux surgery].

Purpose: Evaluation of quality of life data and patient satisfaction to estimate the outcome of laparoscopic antireflux surgery (LARS) is nowadays an important issue, the long-term outcome of this has not yet received much attention.

Methods: In the present study we evaluated the outcome of quality of life data of 70 patients who underwent "floppy" Nissen fundoplication at our institute 3 years after surgery. Quality of life was evaluated with the Gastrointestinal Quality of Life Index (GIQLI).