Pathophysiological measurement and results after laparoscopic fundoplication for gastroesophageal reflux disease.
OBJECTIVE
Both surgical and conservative treatments for gastroesophageal reflux disorder (GERD) are controversial. The aim of this prosepective study was to examine outcomes after laparoscopic antireflux surgery.


METHODS
The subjects were 143 patients who underwent laparoscopic antireflux surgery. Following diagnostic procedures 126 patients were allocated to a total fundoplication group (360 degrees C, Nissen-DeMeester) and 17, to a posterior semifundoplication group (250-270 degrees, Toupet). All complications were registered, and pathophysiological and outcome data were examined 3, 6, and 9 months after surgery.


RESULTS
By 6 months after surgery the mean lower esophageal sphincter (LES) pressure had improved significantly, to 14.8 mmHg in the Nissen-DeMeester group, and to 12.1 mmHg in the Toupet group, corresponding to successful prevention of esophageal reflux in both groups. Dysphagia was more common in the early postoperative period after total fundic wrap (17% vs12%), but this difference disappeared in time. All patients reported complete relief of reflux symptoms, although two of those who underwent the Nissen-DeMeester fundoplication experienced relapse of GERD and required open reconstruction (1.4%). The laparoscopic procedure was converted to open surgery in three patients (2%). There were no associated deaths and the perioperative complication rate was 4.2%.


CONCLUSIONS
Laparoscopic antireflux surgery is an effective treatment for GERD. More than 93% of the patients in this series rated their outcome as good to excellent following the operation.
Ludwig
Kaja
K
Department of Surgery, Suedstadt-Klinikum Rostock, Suedring 81, D-18059 Rostock, Germany.
Bernhardt
Joern
J
Amtsberg
Gerlind
G
Patrzyk
Maczej
M
Wilhelm
Lutz
L
Hoene
Andreas
A
D000328:Adult; D000368:Aged; D004943:Esophagogastric Junction / Q000503:physiopathology; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D010535:Laparoscopy; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation; D016896:Treatment Outcome