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Practice Guideline
. 2024 Nov 28;37(12):doae090.
doi: 10.1093/dote/doae090.

International Society for Diseases of the Esophagus consensus on management of the failed fundoplication

Geoffrey P Kohn  1   2 , Cesare Hassan  3   4 , Edward Lin  5 , Yu-Hong Ian Wong  6 , Sergey Morozov  7   8 , Sumeet Mittal  9 , Sarah K Thompson  10 , Chelsea Lin  11 , David Chen  11 , Jordi Elliott  11 , Varun Jahagirdar  11 , Natasha Newman  11 , Rippan Shukla  12 , Peter Siersema  13 , Giovanni Zaninotto  14 , Ewen A Griffiths  15   16 , Bas P Wijnhoven  17 ; ISDE Collaborating Members Group
Collaborators, Affiliations
Practice Guideline

International Society for Diseases of the Esophagus consensus on management of the failed fundoplication

Geoffrey P Kohn et al. Dis Esophagus. .

Abstract

Fundoplication is a durable, effective, and well-accepted treatment for gastroesophageal reflux disease. Nonetheless, troublesome postoperative symptoms do occasionally occur with management varying widely among centers. In an attempt to standardize definition and management of postfundoplication symptoms, a panel of international experts convened by the Guidelines Committee of the International Society for Diseases of the Esophagus devised a list of 33 statements across 5 domains through a Delphi approach, with at least 80% agreement to establish consensus. Eight statements were endorsed for the domain of Definitions, four for the domain of Investigations, nine for Dysphagia, nine for Heartburn, and four for Revisional surgery. This consensus defined as the treatment goal of fundoplication the resolution of symptoms rather than normalization of physiology or anatomy. Required investigations of all symptomatic postfundoplication patients were outlined. Further management was standardized by patients' symptomatology. The appropriateness of revisional fundoplication and the techniques thereof were described and the role of revisional surgery for therapies other than fundoplication were assessed. Fundoplication remains a frequently-performed operation, and this is the first international consensus on the management of various postfundoplication problems.

Keywords: consensus; evidence-based medicine; fundoplication; gastroesophageal reflux disease; heartburn; regurgitation.

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