[Laparoscopic surgery in the treatment of hiatal hernia and gastroesophageal reflux. Apropos of 172 cases].
Surgical cure of an anomaly of the oesocardial junction was performed 170 times in 172 patients (conversion rate 1.1%). Surgery was indication mainly due to complications of gastro-oesophageal reflux alone (32 cases) or associated with hiatal hernia. The Nissen Rosetti procedure was performed, usually with staple suture (excepting the pillars). A semi-Nissen was performed in 17 cases. There were two major postoperative complications (1.1%) due to necrotic perforation of the lower oesophagus or the greater curvature. Both cases required reoperation on the second and eighth day postoperatively. The postoperative period was uneventful in all the other cases and the mean hospital stay was 4 days. Follow-up examinations included a gastroduodenal contrast study the day after the operation, a fibroscopy at discharge and clinical examination at consultation 7 days later. Later follow-up examinations on day 30 and 90 were completed with a questionnaire or another consultation one year later. Radiography, fibroscopy or pH metry were ordered only for symptomatic patients. Poor functional outcome was observed in two cases with recurrent reflux and in five cases in which spiral procedures were used. Five second laparoscopic operations were successful. Almost all patients had dysphagia after the operation and in 17 cases balloon dilatation was required during the first month after surgery. Persistent dysphagia required the use of a candle twice in one patient. Dysphagia also persisted in one patient with impaired oesophageal motricity. Good and excellent results accounted for 84% of the patients at one year.(ABSTRACT TRUNCATED AT 250 WORDS)
Cady
J
J
Centre hospitalier privé des Yvelines, Sartrouville.
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006551:Hernia, Hiatal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D013997:Time Factors
Traitement coelio-chirurgical des hernies hiatales et du reflux gastro-oesophagien. A propos de 172 cas.