Laparoscopic anti-reflux surgery in patients with systemic sclerosis – report of 2 clinical cases and literature review

Abstract

Introduction. Systemic sclerosis is a rare autoimmune disease, frequently associated with severe esophageal dysmotility and the occurence of gastroesophageal reflux disease (GERD). The indication of laparoscopic fundoplication in these patients is a challenge, considering the high risk of postoperative dysphagia. Purpose. The aim was to perform the review of literature and to present 2 clinical cases of refractory GERD in case of systemic sclerosis from our own experience, including features and early outcomes of laparoscopic fundoplication. Material and methods. We present the clinical cases of 2 women, 60 and 61 years old, with systemic sclerosis (> 30 years) and refractory GERD, operated during 2019, in the Department of General Surgery no.3. Patients were examined pre- and postoperatively clinically, endoscopically, radiologically and ph-metrically. Quality of life of patients - GERD-HRQL questionnaire (Velanovich). Results. In both cases - the typical GERD symptoms. Preoperative instrumental data: endoscopic - cardia insufficiency gr.II and III (Hill) with esophagitis gr.II-III (Savary-Miller); barium esophagogram - aperistaltic esophagus with high reflux, without hernia; ph-metric - DeMeester index of 10.73 and 18.9 (norm <14.7). In both cases was performed laparoscopic posterior cruroplasties with short Nissen-Rossetti fundoplication. Postoperative - regression of symptoms, moderate dysphagia that has regressed in 2-3 weeks. Healing of esophagitis - in both cases. The Velanovich score decreased from 25 and 26 (preoperative) to 3 and 4 (4 and 6 months postoperatively). Conclusions. Despite the risk of postoperative dysphagia, as esophageal motility is often severely compromised in patients with systemic sclerosis, laparoscopic anti-reflux surgery should be considered an effective treatment for recalcitrant GERD, with good results in selected patients.