Laparoscopic Nissen-Rossetti fundoplication is effective to control gastro-oesophageal and pharyngeal reflux detected using 24-hour oesophageal impedance and pH monitoring (MII-pH).
The study aims to evaluate, at medium- and long-term follow-up, the efficacy of Nissen-Rossetti fundoplication to control both gastro-oesophageal and pharyngeal reflux, detected with the use of 24-hour pH-multi-channel intra-luminal impedance. Of the 1000 patients who underwent Nissen-Rossetti fundoplication in our Division since 1972, the laparoscopic approach was adopted in 428 consecutive patients with gastro-oesophageal reflux disease. The study population consisted of patients from this group with one-year follow-up. Thirty-one patients had undergone pre-operative evaluation with pH-multi-channel intra-luminal impedance and were classified on the basis of clinical assessment into gastro-oesophageal, or pharyngeal reflux disease group. Pre-operative data are reported. Comparison between gastro-oesophageal reflux and pharyngeal reflux are extrapolated from pH-multi-channel intra-luminal impedance. No conversion to open surgery and no mortality occurred. A major complication occurred in 4 patients (1.1%) and led to a re-intervention in 3. An excellent outcome was reported in 92.9% of the patients at mean follow-up of 83.2 +/- 7 months. Instrumental outcomes are discussed. In conclusion, Nissen-Rossetti fundoplication provides excellent protection from gastro-oesophgeal and pharyngeal reflux. The use of pH-multi-channel intra-luminal impedance is suitable in patients candidate to anti-reflux surgery to detect non-acid reflux.
Del Genio
G
G
I Division of General and Gastrointestinal Surgery, Second University of Naples, Naples, Italy. gdg@doctor.com
Rossetti
G
G
Brusciano
L
L
Maffettone
V
V
Napolitano
V
V
Pizza
F
F
Tolone
S
S
Del Genio
A
A
Di Martino
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004384:Duodenoscopy; D005260:Female; D018662:Fundoplication / Q000295:instrumentation*; D005764:Gastroesophageal Reflux / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010614:Pharynx / Q000503:physiopathology*; D011182:Postoperative Care