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Fig. 2: Trends in the use of surgery for gastroesophageal reflux disease in Ontario, 1988–2000. The solid line indicates the estimated annual number of antireflux operations (Canadian Classification of Procedures10 codes 54.76, 56.59 and 65.7) and the dashed lines indicate 95% CI. The annual number of procedures was modeled as a function of time using negative binomial regression.11 To produce a smooth curve, time (in fiscal years) was specified as a restricted cubic spline polynomial,12 with a “knot” at the year 1991 (allowing for a change in the rate of surgery at this point, when laparoscopic surgery13 became widespread). The analysis was done using SAS/GENMOD statistical software (SAS Institute, Cary NC).
Fig. 1: Laparoscopic Nissen fundoplication. This operation is done under a general anesthetic and takes 1–2 hours, and patients typically return home after an overnight hospital stay. Most patients are able to resume a normal diet and return to usual activity within 2 weeks. A: placement of ports for laparoscope and instrument access to the abdominal cavity. B: typical fundoplication procedure. The fundus of the stomach is wrapped around the lower esophagus, creating a 1-way valve that prevents the reflux of gastric contents into the esophagus without impeding the transit of swallowed food from the esophagus to the stomach. Most surgeons also repair the diaphragmatic crura (hiatal hernia). After a successful fundoplication, patients should have no heartburn, regurgitation or dysphagia and should be able to burp when necessary. Complications of surgery include mechanical disruption or migration of the fundoplication, recurrent reflux, dysphagia, inability to burp or vomit, bloating and diarrhea. Photo: Marisa Bonofiglio