[Techniques and outcomes of laparoscopic surgery in gastroesophageal reflux disease].
BACKGROUND
The purpose of this study is to report personal experience in laparoscopic antireflux surgery and to analyze the clinical and functional outcomes of this procedure, also in relation to the different techniques used.


METHODS
From 1996 to 2000, 20 patients with gastroesophageal reflux disease associated with hiatal hernia underwent laparoscopic surgery. The indication for surgery was failure of long-term medical therapy. All patients had severe acid reflux on 24 hrs-pH monitoring, endoscopic evidence of esophagitis and hiatal hernia, and defective lower esophageal sphincter. A Nissen fundoplication was performed in 13 patients with normal esophageal body motility, and a 270 degrees posterior fundoplication in seven patients with low esophageal motility.


RESULTS
Mortality and conversion rate were 0. Mean operative time was 135 min and mean postoperative hospital stay 5 days. Operative morbidity was 15%. All the patients were completely cured of reflux symptoms; transient mild postoperative dysphagia occurred in two patients (10%). There was a significantly improvement of the results in postoperative esophageal manometry and 24 hrs-pH monitoring.


CONCLUSIONS
This preliminary experience suggests that laparoscopic surgery represents a safe and effective procedure for the treatment of gastroesophageal reflux disease. Precise selection of patients and adequate surgical technique are essential.
Mastrorilli
M
M
Facoltà di Medicina e Chirurgia, Dipartimento di Chirurgia Generale, Oncologia e Videoassistita, Università degli Studi di Napoli, Federico II, Napoli, Italy.
Benassai
G
G
Quarto
G
G
Cantelmo
A
A
Pastore
M
M
Mastrorilli
G
G
D000328:Adult; D004941:Esophagitis / Q000209:etiology / Q000601:surgery; D004943:Esophagogastric Junction / Q000503:physiopathology; D005260:Female; D018662:Fundoplication / Q000379:methods* / Q000706:statistics & numerical data; D005745:Gastric Acidity Determination; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000601:surgery*; D006551:Hernia, Hiatal / Q000150:complications / Q000601:surgery*; D006801:Humans; D007558:Italy; D010535:Laparoscopy / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome