[The laparoscopic surgical therapy of gastroesophageal reflux disease].
Between January 1995 and February 1997 we performed 30 laparoscopic Nissen-Rossetti fundoplications and 3 laparotomic Nissen fundoplications. All patients were suffering from gastro-esophageal reflux disease (GERD) resistant to medical therapy, 19 patients were suffering also from hiatal hernia and 2 pz. were suffering from a para esophageal hernia. 1 patient had been previously treated with laparotomic Nissen fundoplication for GERD and hiatal hernia. Preoperative assessment included: oesophagogastroduodenoscopy (EGDS) with biopsies: 24-h pH-monitoring; 24-h manometry; barium swallow and DeMeester symptoms scoring. Mean operation time was 110 min. 1 pz. required conversion to laparotomy. 35% of pz. experienced mild grade dysphagia that resolved spontaneously in 4-8 weeks. Postoperative evaluation was performed in all patients 6 months after surgery. Overall results were characterised by a significant reduction of the symptoms score: mean score was reduced from 5.6/9 to 0/9. No signs of oesophagitis were seen at control EGDS. 24-h pH monitoring demonstrated a significant reduction of the total time at ph < 4 from a mean value of 28.2% preoperatively to 1.9% postoperatively. 24 h oesophageal manometry revealed a rise in lower oesophageal sphincter pressure from a mean of 11 mmHg preoperatively to a mean of 27 mmHg postoperatively. Our preliminary results demonstrate that laparoscopic Nissen-Rossetti fundoplication is a safe and effective procedure for gastro-oesophageal reflux disease but, sometimes, laparotomic technique can be considered in selected cases.
Napolitano
L
L
Unità di Chirurgia, Scuola di Specializzazione in Chirurgia Generale, Università di Chieti.
Ciccaglione
A F
AF
Castellano
A
A
Marzio
L
L
Innocenti
P
P
D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000601:surgery*; D006551:Hernia, Hiatal / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D011028:Pneumoperitoneum, Artificial / Q000379:methods