Endoscopic stapling in comparison to laparoscopic fundoplication for the treatment of gastroesophageal reflux disease

Abstract

BACKGROUND: The SRS™ Endoscopic Stapling System (Medigus Ltd, Omer, Israel) is a novel method for the treatment of gastroesophageal reflux disease (GERD). The present study assessed the safety and efficacy of SRS compared with laparoscopic anti-reflux surgery (LARS).

PATIENTS AND METHODS: Of 27 participants, 11 underwent SRS and 16 LARS. Symptoms were assessed using Velanovich GERD-health-related quality of life (GERD-HRQL) scores. The groups were compared in reference to operation time, improvement in GERD-HRQL scores, and postoperative course. Chi-squared and Mann-Whitney-U-tests were used for statistical analysis.

RESULTS: Of 16 (59.3%) male and 11 (40.7%) female patients, mean age was 39.6 (range: 24-60) years and mean body mass index was 26.2 kg/m(2) . Both groups were statistically similar. An esophageal perforation observed in the SRS group completely recovered after over-the-scope clipping. Procedure times for SRSand LARS were 89 and 47 min, respectively (P < 0.05). Mean discharge time was longer for SRS than LARS (3 days vs 1.2 days, P < 0.05). However, this difference disappeared with the exclusion of a complicated patient with long hospitalization in the SRS group. During 6 months mean follow up, proton-pump inhibitor use was insignificantly higher in the SRS group (P > 0.05). Mean GERD-HRQL scores dropped in 87% and in 64% of patients (P > 0.05) from 29.3 to 4.1 and from 24.8 to 8.9 (P = 0.016) in LARS and SRS groups, respectively.

CONCLUSION: The short-term results of SRS are promising. The forthcoming new-generation devices and increasing experience may further improve efficacy and decrease untoward effects.