title: Impact of complete gastric fundus mobilization on outcome after laparoscopic total fundoplication.
abstract: With the objective of further optimizing the outcome of antireflux surgery, we have studied the importance of dividing the short gastric vessels when performing a laparoscopic total fundoplication. Ninety-nine consecutive patients with chronic gastroesophageal reflux disease (GERD) were enrolled in the trial. Forty-seven patients (25 men, age 52 +/- 1.6 years [mean +/- standard error]) were randomized to undergo a laparoscopic Nissen-Rossetti total fundic wrap with intact short gastric vessels, whereas 52 patients (29 men, 48 +/- 1.4 years) had complete division of these vessels. Quality of life was assessed by means of the psychological general well-being and gastrointestinal symptom rating scale indices. The 6- and 12-month follow-up data are reported. Two patients were converted to open surgery. Mobilization of the fundus significantly prolonged the operative time (120 vs. 104 minutes, P = 0.05); otherwise the complication rates were similar in the two groups. Both procedures were equally effective in controlling gastroesophageal reflux at 6 and 12 months' postoperatively. Division of the short gastric vessels had no significant impact on the point prevalence of postfundoplication complaints at the given follow-up time points. Quality of life was significantly improved by both operative procedures and remained "normal" throughout the follow-up period. Dividing all short gastric vessels had no impact on the functional outcome during the first year of recovery after a total laparoscopic fundoplication.
authors.affiliation: Department of Surgery, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden. anne.blomqvist@medfak.gu.se
authors.forename: A
authors.initials: A
authors.lastname: Blomqvist
authors.forename: J
authors.initials: J
authors.lastname: Dalenbäck
authors.forename: C
authors.initials: C
authors.lastname: Hagedorn
authors.forename: H
authors.initials: H
authors.lastname: Lönroth
authors.forename: A
authors.initials: A
authors.lastname: Hyltander
authors.forename: L
authors.initials: L
authors.lastname: Lundell
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005748:Gastric Fundus; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D016896:Treatment Outcome