Preoperative endoscopic grading of esophagitis versus outcome after laparoscopic Nissen fundoplication.
OBJECTIVE
Preoperative grading of esophagitis has recently been advocated as a means of selecting patients suitable either for laparoscopic Nissen fundoplication for patients with uncomplicated esophagitis, or for open operations in patients with complicated esophagitis (stricture or Barrett's esophagus). This study was performed to determine whether the degree of esophagitis preoperatively influences the clinical outcome after laparoscopic Nissen fundoplication.


METHODS
Two hundred thirty-one patients who underwent a laparoscopic Nissen fundoplication were classified into three groups according esophagitis grade. Of these patients, 59 had no evidence of endoscopic esophagitis (group 1), 148 had uncomplicated esophagitis (group 2), and 24 had Barrett's esophagus or an esophageal stricture (group 3). Postoperative clinical assessment of heartburn, dysphagia, and patient satisfaction using visual analogue scales was performed by an independent investigator.


RESULTS
No significant differences were found between the groups in regard to their clinical outcome.


CONCLUSIONS
We conclude that laparoscopic Nissen fundoplication is a suitable approach for all patients with objectively proven gastroesophageal reflux disease selected for surgery, irrespective of their preoperative esophagitis grade.
Watson
D I
DI
Royal Adelaide Centre for Endoscopic Surgery, Royal Adelaide Hospital, South Australia.
Foreman
D
D
Devitt
P G
PG
Jamieson
G G
GG
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000175:diagnosis / Q000601:surgery; D004940:Esophageal Stenosis / Q000175:diagnosis / Q000601:surgery; D004941:Esophagitis / Q000145:classification / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D004945:Esophagoscopy; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011300:Preoperative Care; D016896:Treatment Outcome