[Results of fundoplication by laparoscopic approach in the treatment of gastroesophageal reflux. Apropos of 224 cases].
OBJECTIVE
The aim of this paper is to evaluate prospectively immediate and 2-year results of laparoscopic fundoplicature (LF) for gastroesophageal reflux disease (GERD).


METHODS
Patients presenting GERD who had been previously submitted to a long-term medical treatment were included in this study. Preoperative workup included upper GI tract endoscopy, esophageal manometry and 24-hour pHmetry. Standard surgical procedure incorporated a Nissen-Rossetti 360 degrees fundoplicature. Short vessels division (Nissen operation) was performed in case of high strength of the wrap and a partial fundoplicature (Toupet 270 degrees) was performed when motility disorders of the esophagus were demonstrated by manometry. Postoperative morbidity and results were evaluated, with a clinical appreciation at 3 and 22 months, and by manometry and pHmetry at 3 months.


RESULTS
Two hundred and thirty-five patients were observed, and 224 included in the study (143 men and 92 women). Nissen-Rossetti fundoplication was performed in 169 cases (80%), Nissen in 30 (14%) and Toupet in 13 (6%). In 12 cases (5%). LF was converted to an open Nissen-Rossetti procedure. There was no hospital mortality and complications were noted in three cases (1.5%): pneumonia (n = 2) and gastroplegia (n = 1). With a mean 22-month follow up, among the 103 patients who answered to a questionnaire, the rate of relapse of GERD was 14%, dysphagia was present in 2% and four patients had been reoperated on (one for a slipped Nissen, one for a stenosis of the esogastric junction and two incisional hernias).


CONCLUSIONS
On the basis of this experience, LF for GERD is a safe and efficient operation, with 86% of good results at 2 years.
Meyer
C
C
Service de chirurgie générale et digestive, centre hospitalier universitaire de Strasbourg Hautepierre, France.
Firtion
O
O
Rohr
S
S
de Manzini
N
N
Le
J V
JV
Thiry
L C
LC
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D016896:Treatment Outcome