What is the real value of antireflux surgery?
OBJECTIVE
The purpose of this study was to evaluate the changes in esophageal physiology that are produced after laparoscopic surgery in patients with gastroesophageal reflux disease (GERD).


METHODS
From May 1996 until January 2000, 13 patients with GERD underwent antireflux laparoscopic surgery. In 8 patients, preoperative manometric studies showed motility disorders characterized by a decrease in the percentage of primary peristaltic waves (32% average), a reduction in the pressure of the waves (40 mm Hg average), and a decrease in the percentage of the physiological waves (7.4% average). Laparoscopic Toupet fundoplication was the surgical procedure used in all cases, without complications and with a good postoperative course. Esophageal manometry was performed 8 weeks after the operation in 7 patients.


RESULTS
The results revealed an increase in the percentage of primary peristaltic waves (76.4% average) (P = 0.05906 Wilcoxon Test); an increase in the wave pressure (57 mm Hg average) (P = 0.1056); and an increase in the percentage of the physiological waves (45.8% average) (P = 0.05906).


CONCLUSIONS
Our final conclusion was that antireflux laparoscopic surgery, in this specific case the Toupet (partial) fundoplication, induced recovery in esophageal motility in those patients with peristaltic alterations due to reflux. This plays an important role in disease control because the recovery of esophageal peristalsis allows an increase in its emptying and reduces the possibility of esophageal damage by reflux episodes that could persist even though a fundoplication was constructed.
General Surgery, School of Clinical and Therapeutical Surgery B, Faculty of Medicine, Universidad Central de Venezuela. sana24@telcel.net.ve
Salvador
S
Navarrete
Jose Luis
JL
Leyba
Alejandra
A
Dehollain
Salvador
S
Navarrete Li
D000293:Adolescent; D000328:Adult; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011183:Postoperative Complications; D016896:Treatment Outcome