[The laparoscopic treatment of functional esophageal diseases. Preliminary experience with Nissen's intervention and Heller-Dor's intervention].
Aim of the study is to analyse the preliminary results that we obtained with laparoscopic surgery for esophageal functional diseases. Twenty four patients between April 1992 and December 1993 underwent laparoscopic procedures for gastroesophageal reflux disease and achalasia, respecting the same principles adopted for the traditional surgery. A 360 degrees Nissen fundoplication modified according to DeMeester was performed in 12 patients with severe cardial incontinence or reducible gastric hiatal hernia. The 12 patients with achalasia underwent esophagogastric myotomy associated with a Dor hemifundoplication. Myotomy and gastroplasty were performed under manometric control. The mortality was zero in both techniques. All Nissen procedures were completed laparoscopically, while 2 Heller-Dor were converted to the laparotomy version. The mean duration time of the procedure has been 190' for the Nissen operation and 230' for the Heller-Dor. In one patient submitted to the antireflux gastroplasty occurred a pleural effusion. The short term results (mean follow-up 6 months) of the laparoscopic procedures were comparable with the traditional laparotomy operation.


CONCLUSIONS
the two procedures are feasible via laparoscopy; the intraoperative manometry is useful for the Heller-Dor operation; the laparoscopic approach for functional diseases must be considered experimental until were obtained satisfactory long term results.
Gozzetti
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G
Istituto di Clinica Chirurgica II, Università degli Studi di Bologna.
Mattioli
S
S
Di Simone
M P
MP
D000328:Adult; D000368:Aged; D004931:Esophageal Achalasia / Q000601:surgery; D004935:Esophageal Diseases / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery; D006551:Hernia, Hiatal / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged