title: Laparoscopic Nissen-Rossetti fundoplication with routine use of intraoperative endoscopy and manometry: technical aspects of a standardized technique.
abstract: BACKGROUND
  Several different ways of fashioning a total fundoplication lead to different outcomes. This article addresses the technical details of the antireflux technique we adopted without modifications for all patients with GERD beginning in 1972. In particular it aims to discuss the relation between the mechanism of function of the wrap and the physiology of the esophagus.
  
  
  METHODS
  The study population consisted of 380 patients affected by GERD with a 1-year minimum of follow-up who underwent laparoscopic Nissen-Rossetti fundoplication by a single surgeon.
  
  
  RESULTS
  No conversion to open surgery and no mortality occurred. Major complications occurred in 4 patients (1.1%). Follow-up (median 83 months; range: 1-13 years) was achieved in 96% of the patients. Ninety-two percent of the patients were satisfied with the results of the procedure and would undergo the same operation again. Postoperative dysphagia occurred in 3.5% of the patients, and recurrent heartburn was observed in 3.8%.
  
  
  CONCLUSIONS
  Laparoscopic Nissen-Rossetti fundoplication with the routine use of intraoperative manometry and endoscopy achieved good outcomes and long-term patient satisfaction with few complications and side-effects. Appropriate preoperative investigation and a correct surgical technique are important in securing these results.
authors.affiliation: First Division of General and Gastrointestinal Surgery, Second University of Naples, via Pansini, 5 I-80131, Naples, Italy. gdg@doctor.com
authors.forename: Gianmattia
authors.initials: G
authors.lastname: del Genio
authors.forename: Gianluca
authors.initials: G
authors.lastname: Rossetti
authors.forename: Luigi
authors.initials: L
authors.lastname: Brusciano
authors.forename: Paolo
authors.initials: P
authors.lastname: Limongelli
authors.forename: Francesco
authors.initials: F
authors.lastname: Pizza
authors.forename: Salvatore
authors.initials: S
authors.lastname: Tolone
authors.forename: Landino
authors.initials: L
authors.lastname: Fei
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Maffettone
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Napolitano
authors.forename: Alberto
authors.initials: A
authors.lastname: del Genio
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods* / Q000592:standards; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000592:standards; D008297:Male; D008365:Manometry; D008875:Middle Aged; D016896:Treatment Outcome