[Cardiopexy using the hepatic ligament in the treatment of gastroesophageal reflux. Apropos of 200 cases].
The authors report 200 cases of cardiopexy with the ligamentum teres (Rampal-Marchal's procedure) associated with a 180 degree posterior fundoplication, in the surgical treatment of gastroesophageal reflux. 200 patients with severe reflux (76% oesophagitis) were operated on with this procedure over a 10 year period. Symptoms of reflux disappeared immediately in 99% cases, with healing of oesophagitis in 124 out of the 127 patients controlled with endoscopy, and a significant increase of inferior sphincteric pressure (from 11 cm H2O to 25 cm H2O). Objective controls by post-prandial pHmetry evidenced persistant reflux with 10 patients, but 9 of them are totally free of symptoms. Operative mortality was 1.5%. Transient dysphagia was observed in 32% cases. All the patients were reviewed with a mean follow up of 23 months. 4 clinical recurrences of reflux were observed (2%) but no oesophagitis was found on endoscopic controls with these 4 patients, and only one had to be reoperated on. Actuarial chance to remain free of recurrence was estimated at 97.8% up to 48 months according to the Kaplan-Maier's method. Cardiopexy with the ligamentum teres ensures the lengthening of the abdominal portion of the oesophagus and anchors the antireflux assembly within the pressure environment of the abdomen in a strong and flexible way. It seems to be the best procedure for the treatment of GE reflux.
Flament
J B
JB
Service de Chirurgie Générale et Digestive, Hôpital Robert-Debré, Reims.
Plet
H
H
Palot
J P
JP
Delattre
J F
JF
Cazabat
A
A
Thiefin
G
G
D002299:Cardia / Q000601:surgery*; D003680:Deglutition Disorders / Q000209:etiology; D004942:Esophagitis, Peptic / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005748:Gastric Fundus / Q000601:surgery; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D008022:Ligaments / Q000601:surgery / Q000637:transplantation*; D008099:Liver; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012008:Recurrence
Cardiopexie par le ligament rond dans le traitement du reflux gastro-oesophagien. A propos de 200 interventions.