Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2022 Dec;36(12):9345-9354.
doi: 10.1007/s00464-022-09209-7. Epub 2022 Apr 12.

Review of SAGES GERD guidelines and recommendations

Cassandra Mohr  1   2 , Hailie Ciomperlik  3 , Naila Dhanani  3 , Oscar A Olavarria  3 , Craig Hannon  3 , William Hope  4 , Scott Roth  5 , Mike K Liang  6 , Julie L Holihan  3
Affiliations
Multicenter Study

Review of SAGES GERD guidelines and recommendations

Cassandra Mohr et al. Surg Endosc. 2022 Dec.

Abstract

Background: The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) developed evidence-based guidelines for the management of patients with gastroesophageal reflux disease (GERD). The aim of this study is to evaluate guidelines lacking agreement among experts (grades B-D) or lacking support from randomized controlled trials (levels II-III).

Methods: Six guidelines were chosen for evaluation. A retrospective review of a multicenter database of patients undergoing fundoplication surgery for treatment of GERD between 2015 and 2020 was performed. Patients that underwent a concurrent gastrectomy or were diagnosed with pre-operative achalasia were excluded. Demographics, pre-operative, intra-operative, and post-operative variables were collected. Post-operative outcomes were evaluated based on selected SAGES guidelines. Outcomes were assessed using multivariable regression or stratified analysis for each guideline.

Results: A total of 444 patients from four institutions underwent surgery for the management of GERD with a median (interquartile range) follow-up of 16 (13) months. Guidelines supported by our data were (1) robotic repair has similar short-term outcomes to laparoscopic repair, (2) outcomes in older patients are similar to outcomes of younger patients undergoing antireflux surgery, and (3) following laparoscopic antireflux surgery, dysphagia has been reported to significantly improve from pre-operative values. Guidelines that were not supported were (1) mesh reinforcement may be beneficial in decreasing the incidence of wrap herniation, (2) a bougie has been found to be effective, and (3) the long-term effectiveness of fundoplication in obese individuals (BMI > 30) has been questioned due to higher failure rates.

Conclusion: Many SAGES GERD guidelines not receiving Grade A or Level I recommendation are supported by large, multicenter database findings. However, further studies at low risk for bias are needed to further refine these guidelines.

Keywords: Fundoplication; GERD; Guidelines.

PubMed Disclaimer

References

    1. Stefanidis D, Hope W, Kohn G, Reardon P, Richardson W, Fanelli R, Guidelines Committee SAGES (2010) Guidelines for surgical treatment of gastroesophageal reflux disease (GERD). Surg Endosc. https://doi.org/10.1007/s00464-010-1267-8 - DOI - PubMed
    1. Granderath FA, Schweiger UM, Kamolz T, Asche KU, Pointner R (2005) Laparoscopic Nissen fundoplication with prosthetic hiatal closure reduces postoperative intrathoracic wrap herniation: preliminary results of a prospective randomized functional and clinical study. Arch Surg. https://doi.org/10.1001/archsurg.140.1.40 - DOI - PubMed
    1. Morino M, Pellegrino L, Giaccone C, Garrone C, Rebecchi F (2006) Randomized clinical trial of robot-assisted versus laparoscopic Nissen fundoplication. Br J Surg. https://doi.org/10.1002/bjs.5325 - DOI - PubMed
    1. Cadière GB, Himpens J, Vertruyen M, Bruyns J, Germay O, Leman G, Izizaw R (2001) Evaluation of telesurgical (robotic) NISSEN fundoplication. Surg Endosc. https://doi.org/10.1007/s004640000217 - DOI - PubMed
    1. Nakadi IE, Mélot C, Closset J, DeMoor V, Bétroune K, Feron P, Lingier P, Gelin M (2006) Evaluation of da Vinci Nissen fundoplication clinical results and cost minimization. World J Surg. https://doi.org/10.1007/s00268-005-7950-6 - DOI - PubMed

Publication types

LinkOut - more resources