Prospective evaluation of laparoscopic and open 360 degree fundoplication in mild and severe gastro-oesophageal reflux disease.
OBJECTIVE
To investigate the relationship between five-year control of reflux and early postoperative oesophageal function after total fundoplication done either laparoscopically or through a laparotomy in severe and mild reflux disease.


METHODS
Prospective open study.


METHODS
University hospital, Sweden.


METHODS
In the group with severe disease 9 patients had a laparotomy and 7 laparoscopy. The corresponding figures for the group with mild disease were 21 and 34 respectively.


RESULTS
The increase in lower oesophageal sphincter pressure 6 months after operation in patients with recurrent disease was significantly less than that for patients with good reflux control (p < 0.01). In patients who had laparotomy, including 30% (9/30) with severe reflux disease, good long-term reflux control was found in 93% (27/29). In patients operated on laparoscopically including 17% (7/41) with severe reflux disease good long-term reflux control was found in 90% (35/39).


CONCLUSIONS
The mechanism of recurrence differed between patients with severe disease who had a laparotomy and patients with mild disease operated on laparoscopically. Early postoperative manometry was prognostic for recurrence. Long-term reflux control seems to be similar after laparotomy and laparoscopy. Further randomised studies are needed.
Franzén
Thomas
T
Department of Surgery, University Hospital, Linköping, Sweden. thomas.franzen@lio.se
Anderberg
Bo
B
Tibbling Grahn
Lita
L
Johansson
K E
KE
D003938:Diagnostic Techniques, Digestive System; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000517:prevention & control / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy; D008297:Male; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome