[Intraoperative endoscopy in laparoscopic fundoplications].
BACKGROUND
Laparoscopic fundoplications are the standard surgical treatment of patients with gastroesophageal reflux disorder. Adequate technique is the most important outcome factor. There is no standardized method to evaluate the procedure itself. Intraoperative endoscopy is a method to evaluate laparoscopic fundoplications.


METHODS
This was a retrospective observational study of patients undergoing laparoscopic fundoplications from July 1999 to June 2004, excluding open procedures and reoperations of previous failed laparoscopic fundoplications. Intraoperative endoscopy was performed during the dissection and suturing of the procedure to determine if correction of the technique is necessary. Number of changes were recorded and analyzed with Student's t-test.


RESULTS
Three hundred patients were operated on, 23 were excluded (14 reoperations and nine conventional laparotomies). Of the 277 patients included, 178 were males and 99 females. Average age was 43.4 +/- 14 years (range: 12-85). There were 71 Toupet and 206 Nissen fundoplications. Intraoperative endoscopy determined correction of the technique in 77 patients with 1.69 +/- 0.96 changes; 68 rotated and/or angled fundoplications, one rotation with distended stomach, one redundant gastric fundus, and seven change in the type of fundoplication from Nissen to Toupet because of tightness (3.7 +/- 1.1 changes, p = 0.0001) to achieve adequate fundoplication.


CONCLUSIONS
Intraoperative endoscopy confirms adequate technique and prevents inadequate laparoscopic fundoplications. Further studies will determine if routine use is justified to prevent postoperative complications and to improve outcome.
Becerril-Martínez
Guillermo
G
Departamento de Cirugía Endoscópica, American British Cowdray Medical Center, IAP. dr.becerril@gmail.com
Decanini-Terán
César
C
Spaventa-Ibarrola
Antonio
A
Farca-Belsaguy
Alberto
A
Fournier-Montemayor
Francisco
F
Menéndez-Skertchly
Ana Luisa
AL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D007430:Intraoperative Care; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome