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Abstract
Introduction Surgical management of anatomical and functional failure of the lower oesophageal sphincter is becoming increasingly complex with advances in diagnostics, eg. high-resolution manometry (HRM), and further therapeutic options such as magnetic-bead sphincter augmentation (MSA).1With the increasing incidence in functional bowel / motility disorders which may create worse surgical outcomes, there is a need for specialisation in this field. We report on the development of a specialist anti-reflux service including the changing role of surgery and the increasing importance of physiology investigations.
Method Data was retrieved from a prospective databases maintained by the clinical measurements and surgical departments to identify patients undergoing physiology investigations and surgical intervention over a 5 year period 2010–2014, since the start of the specialist service. Surgical data was cross-referenced against hospital coding data.
Results Following introduction of a specialist anti-reflux clinic there has been a sustained rise in new referrals to the clinic (Figure 1)and patients treated surgically. Recent years have also seen a trend to increasing use of second generation physiology investigations such aswireless pH monitoring and HRM, as well as a rise in the total number of investigations (Figure 2). A peak in the upward trend was associated with the introduction of MSA, with subsequent divergence of MSA and fundoplication reflecting the relative popularity of these procedures (Figure 3). There was no significant change in the frequency of complex para-oesophageal hernia repair over the same period.
Number of new pts seen in anti-reflux clinic per month (with trend line)
Investigations performed (pH monitoring, oesophageal manometry (OM), wireless pH monitoring and high resolution manometry (HRM))
Number of procedures, including para-oesophageal hernia repairs, fundoplications and MSA, as well as total anti-reflux procedures (Sum of Fundoplication+MSA)
Conclusion Introduction of a specialist anti-reflux service has led to a rise in the number of physiology investigation requested and patients treated operatively. Magnetic-bead sphincter augmentation appears to be a more acceptable alternative for patients than traditional fundoplication. Guidance and service requirements need to be developed including the identification of standards and quality indicators in the field of anti-reflux surgery to optimise patient outcomes in a field where an increased range of investigation and management expertise are required.
Disclosure of interest None Declared.
Reference
Bonavina, et al. Ther Adv Gastroenterol. 2013;6(4):261–8