Rekomendasi Pemilihan Pasien untuk Operasi Antirefluks

Oleh :

dr. Sonny Seputra, Sp.B, M.Ked.Klin, FINACS

Operasi antirefluks bisa dijadikan modalitas tata laksana gastroesophageal reflux disease (GERD). GERD adalah kondisi refluks isi duodenum atau gaster ke dalam esofagus, menyebabkan gejala dan kerusakan jaringan esofagus berupa esofagitis, striktur esofagus, dan Barrett's esophagus.[1,2]

Proton pump inhibitor (PPI) adalah terapi medikamentosa lini pertama untuk pasien dengan GERD. Terapi PPI telah terbukti efektif dalam penyembuhan esofagitis akibat GERD. Akan tetapi, PPI memiliki kekurangan, yaitu angka kegagalan terapi dalam menghilangkan gejala GERD yang cukup besar, yaitu 10–40%. Selain itu, hanya 58% dari pasien GERD yang merasa puas dengan hasil terapi PPI. Penggunaan PPI jangka panjang juga ditemukan berkaitan dengan risiko keganasan.[3,4]

Ketika terapi medikamentosa dengan antasida, antagonis reseptor histamin 2, dan PPI untuk terapi GERD gagal, operasi antirefluks dapat dipertimbangkan. Operasi antirefluks juga dapat direkomendasikan jika terjadi intoleransi terhadap PPI atau sebagai alternatif dalam mengantisipasi terapi medis jangka panjang pada pasien muda dengan GERD.

(Konten ini khusus untuk dokter. Registrasi untuk baca selengkapnya)

Referensi

1. Vakil N, van Zanten SV, Kahrilas P, et al. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 2006;101:1900–20.
2. Pauwels A, Boecxstaens V, Andrews CN, et al. How to Select Patients for Antireflux Surgery? The ICARUS Guidelines (International Consensus Regarding Preoperative Examinations and Clinical Characteristics Assessment to Select Adult Patients for Antireflux Surgery). Gut, 2019;68:1928–1941.
3. Dean BB, Gano AD, Knight K, et al. Effectiveness of proton pump inhibitors in nonerosive reflux disease. Clin Gastroenterol Hepatol 2004;2:656–64.
4. Fass R, Sifrim D. Management of heartburn not responding to proton pump inhibitors. Gut 2009;58:295–309.
5. Antunes C, Aleem A, Curtis SA. Gastroesophageal Reflux Disease. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. https://www.ncbi.nlm.nih.gov/books/NBK441938/
6. Gordon C, Kang JY, Neild PJ, et al. The role of the hiatus hernia in gastrooesophageal reflux disease. Aliment Pharmacol Ther 2004;20:719–32
7. Maret-Ouda J, Markar SR, Lagergren J. Gastroesophageal Reflux Disease: A Review. JAMA. 2020 Dec 22;324(24):2536-2547. doi: 10.1001/jama.2020.21360. PMID: 33351048.
8. Müller-Stich BP, Achtstätter V, Diener MK, et al. Repair of paraesophageal hiatal hernias—is a fundoplication needed? A randomized controlled pilot trial. J Am Coll Surg 2015;221:602–10.
9. Hayden J, Jamieson G. Optimization of outcome after laparoscopic antireflux surgery. ANZ J Surg 2006;76:258–63.
10. Aziz Q, Fass R, Gyawali CP, et al. Esophageal Disorders. Gastroenterology 2016;150:1368–79.
11. Dellon ES, Farrell TM, Bozymski EM, et al. Diagnosis of eosinophilic esophagitis after fundoplication for ’refractory reflux’: implications for preoperative evaluation. Dis Esophagus 2010;23:191–5.
12. Slater BJ, Dirks RC, McKinley SK, Ansari MT, Kohn GP, Thosani N, Qumseya B, Billmeier S, Daly S, Crawford C, P Ehlers A, Hollands C, Palazzo F, Rodriguez N, Train A, Wassenaar E, Walsh D, Pryor AD, Stefanidis D. SAGES guidelines for the surgical treatment of gastroesophageal reflux (GERD). Surg Endosc. 2021 Sep;35(9):4903-4917. doi: 10.1007/s00464-021-08625-5. Epub 2021 Jul 19. PMID: 34279710.
13. Chisholm JA, Jamieson GG, Lally CJ, et al. The effect of obesity on the outcome of laparoscopic antireflux surgery. J Gastrointest Surg 2009;13:1064–70
14. Dibley LB, Norton CS, Jones R. Is there a role for lifestyle education in the management of gastro-oesophageal reflux disease? Eur J Gastroenterol Hepatol 2009;21:1229–40.
15. Niebisch S, Fleming FJ, Galey KM, et al. Perioperative risk of laparoscopic fundoplication: safer than previously reported-analysis of the American College of Surgeons National Surgical Quality Improvement Program 2005 to 2009. J Am Coll Surg 2012;215:61–8.
16. Clarke JO, Fernandez-Becker NQ, Regalia KA, Triadafilopoulos G. Baclofen and gastroesophageal reflux disease: seeing the forest through the trees. Clin Transl Gastroenterol. 2018 Mar 29;9(3):137. doi: 10.1038/s41424-018-0010-y. PMID: 29599487; PMCID: PMC5876385.
17. Attwood SE dan Galmiche JP. A debate on the roles of antireflux surgery and long term acid suppression in the management of gastro-oesophageal reflux disease. Frontline Gastroenterol. 2011 Oct; 2(4): 206–211.
18. Rosenthal R, Peterli R, Guenin MO, et al. Laparoscopic antireflux surgery: long-term outcomes and quality of life. J Laparoscopic Adv Surg Tech A 2006;16:557–61.
19. Rodríguez de Santiago E, Albéniz E, Estremera-Arevalo F, Teruel Sanchez-Vegazo C, Lorenzo-Zúñiga V. Endoscopic anti-reflux therapy for gastroesophageal reflux disease. World J Gastroenterol. 2021 Oct 21;27(39):6601-6614. doi: 10.3748/wjg.v27.i39.6601. PMID: 34754155; PMCID: PMC8554403.
20. McKinley SK, Dirks RC, Walsh D, Hollands C, Arthur LE, Rodriguez N, Jhang J, Abou-Setta A, Pryor A, Stefanidis D, Slater BJ. Surgical treatment of GERD: systematic review and meta-analysis. Surg Endosc. 2021 Aug;35(8):4095-4123. doi: 10.1007/s00464-021-08358-5. Epub 2021 Mar 2. PMID: 33651167.
21. Yodice M, Mignucci A, Shah V, Ashley C, Tadros M. Preoperative physiological esophageal assessment for anti-reflux surgery: A guide for surgeons on high-resolution manometry and pH testing. World J Gastroenterol. 2021 Apr 28;27(16):1751-1769. doi: 10.3748/wjg.v27.i16.1751. PMID: 33967555; PMCID: PMC8072189.
22. Fuchs KH, Breithaupt W, Varga G, Babic B, Schulz T, Meining A. Primary laparoscopic fundoplication in selected patients with gastroesophageal reflux disease. Dis Esophagus. 2022 Jan 7;35(1):doab032. doi: 10.1093/dote/doab032. PMID: 34002235.