Please click on the image below to access

 

 Update to outstanding questions from the live chat box for Wednesday Upper GI session, answers in blue provided by Professor David I Watson, Matthew Flinders Distinguished Professor of Surgery

  
Muthukumaran Rangarajan  What does the UK data recommend regarding short gastric vessel division?  I don’t know what UK data there is. The international data from 6 RCTs is that outcomes are not improved by dividing these vessels, and bloating is actually worse if the vessels are divided. Please see the following reference for a full answer and explanation – Engström C, Jamieson GG, Devitt PG, Watson DI. Meta-analysis of two randomized controlled trials to identify long-term symptoms after division of short gastric vessels during Nissen fundoplication. Br J Surg (2011) 98:1063-1067.

 

Muthukumaran Rangarajan  Resolution of Barrett’s Oesophagus following anterior versus Nissen? Resolution of Barrett’s is uncommon after any type of fundoplication. There is no evidence comparing fundoplication types for this outcome, but as this occurs in <10% of patients, it is unlikely that a valid study could be designed to answer this.
 
mswadley66  Mechanical complications are not just related to the type of wrap. Cruroplasty is also important. Is it controlled in these studies? Agree that the hiatal closure can impact dysphagia, and a tight closure will often require further interventions. In our experience with re-op surgery for dysphagia, the hiatus usually requires widening and wrap usually looks loose, so we deal with both, irrespective of what the cause is thought to be – only want to go back once! In our trials of partial vs Nissen, hiatal closure was standardised, and randomisation was for the wrap only after the hiatal closure was completed. There were not technical differences in the procedures from the perspective of hiatal closure.
 
Ash Bohra For wraps is there any experience on wrap size, please? Not entirely sure what the question is. We are happy with partial wraps , and they would now be 85-90% of all procedures. Wrap length for a Nissen is 1.5-2cm (3 sutures). Evidence from the 1970s and 80s suggests Nissens should be kept short.