Long-term control of gastroesophageal reflux disease symptoms after laparoscopic Nissen-Rosetti fundoplication.
Laparoscopic fundoplication is the gold standard surgical treatment for gastroesophageal reflux disease, although some patients develop recurrence or collateral symptoms related to surgery. The aims of this study were to describe the long-term symptoms control in patients undergoing laparoscopic fundoplication, to analyze the patterns of failure and to correlate postoperative symptoms with anatomic and physiologic findings. Extensive preoperative and postoperative work-up including symptom questionnaire, barium meal, endoscopy, manometry, and 24-hour pH-metry were performed in 130 consecutive patients undergoing laparoscopic fundoplication. Mean follow-up was 52 months. After laparoscopic fundoplication, 117 patients (90%) were asymptomatic with Visick grade I and II symptoms reported by 124 patients (95%). On evaluation, 119 (92%) patients were satisfied and willing to repeat surgery. Two failure patterns, anatomic abnormalities (wrap migration into the chest or down onto the stomach with or without repair disruption) and functional (incompetence of antireflux mechanism), were reported in 17 patients. Reflux can be controlled in up to 90% of patients with gastroesophageal reflux disease with relatively few complications and a high degree of patient satisfaction. The most common cause of recurrent symptoms is an anatomic failure of the fundoplication.
Vidal
Oscar
O
From the Section of Gastrointestinal Surgery and Digestive Motility Unit, Institute of Digestive Diseases, Hospital Clinic, University of Barcelona Medical School, Barcelona, Spain.
Lacy
Antonio Maria
AM
Pera
Manuel
M
Valentini
Mauro
M
Bollo
Jesus
J
Lacima
Gloria
G
Grande
Luis
L
D005260:Female; D018662:Fundoplication / Q000009:adverse effects / Q000379:methods; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008365:Manometry; D017060:Patient Satisfaction; D016896:Treatment Outcome