Anti-Reflux Surgery

Anti-Reflux Surgery of the Future - An interview with Prof. Dr. Schoppmann from the Medical University of Vienna

Can you give us an insight into how Anti-reflux surgery has developed in recent years and what progress you have made or plan to make with your research?

Prof. Dr. Schoppmann: There are several points worth mentioning. The high degree of specialization in this area is very important. Reflux centers have been established that are not only specialized, but also work on an interdisciplinary basis. These centers bring together doctors from different specialties – gastroenterologists, radiologists, surgeons, nutritionists and physiologists – who work together to achieve the best possible treatment success. Anti-reflux surgery requires a high degree of teamwork.

What technical developments have played a role recently?

Prof. Dr. Schoppmann: There have been significant technical innovations. Today, anti-reflux surgery is almost exclusively minimally invasive. New medical devices have not only simplified and standardized operations, but have also reduced side effects. Another development concerns patient selection. Scientific advances have helped us to better understand and measure the pathophysiological mechanisms of reflux disease, allowing us to make more precise diagnoses.

What does the patient structure look like? How many people are affected by reflux?

Prof. Dr. Schoppmann: It is assumed that around 15-20% of the Western population suffer from pathological reflux. Reflux is one of the most important lifestyle diseases: Photo: Katarina Lindbichler JOURNAL for Private Medicine 1/2024 21 caused by factors such as obesity, increased sugar and carbohydrate consumption and genetic influences. For example, some families have a lower collagen expression pattern, which increases the likelihood of reflux disease.

Do you see robot-assisted surgery as a development opportunity for the future?

Prof. Dr. Schoppmann: Yes, the future of anti-reflux surgery is certainly robot-assisted. We are already using robotics and will do so even more frequently in the future, especially for longer procedures. Data shows that robot-assisted surgery offers advantages, particularly for larger hiatal and paraesophageal hernias.

What challenges do you see in current Anti-reflux surgery and how can your research help to overcome them?

Prof. Dr. Schoppmann: In recent years, we have focused on clearly defining the structural changes in patients that lead to reflux disease requiring treatment. Important causes are hiatal hernia and problems with the lower oesophageal sphincter. We also compare new techniques such as magnetic ring, silicone ball and electrical stimulator implantation with conventional surgery to find the best possible treatment method.

What indicators are important for a patient to be considered in your field of research?

Prof. Dr. Schoppmann: A precise symptom history and objectification of the reflux disease are crucial. Methods such as swallowing videocinematography, high-resolution manometry, planimetry and impedance-pH-metry help us to make a precise diagnosis. In addition to surgical treatments, aetiological measures and lifestyle adaptations also play an important role. In addition, proton pump inhibitors are very effective in many cases, although they are viewed critically in long-term use.

What role does interdisciplinary collaboration play in your research team?

Prof. Dr. Schoppmann: Collaboration with gastroenterological colleagues, ENT specialists, dentists and radiologists is essential. This interdisciplinary cooperation enables us to optimize the primary indication and conduct studies and research at a high level.

How could your research findings influence clinical practice?

Prof. Dr. Schoppmann: Objective measures such as planimetry and high-resolution manometry as well as intraoperative measurements improve our understanding of reflux disease and its treatment. These objective parameters allow us to compare different methods and choose the best treatment approaches. Our results show that younger patients with a shorter medical history benefit from surgical treatment and often reject long-term drug therapy.

Finally, what are your hopes and goals for the future of your work in this field?

Prof. Dr. Schoppmann: Our goal is further specialization, centralization and personalization of reflux treatment as well as the development of clear selection criteria for surgical interventions. Austria is well positioned internationally. The founding of the European Foregut Society (EFS) five years ago has made our center internationally known and enables us to conduct research and studies at the highest level.