A modified approach to laparoscopic antireflux surgery may decrease postoperative dysphagia and gas bloat syndrome.
BACKGROUND
Laparoscopic antireflux surgery has passed the test of time to prove its efficacy and advantage over the traditional approach. Several modifications of the original Nissen fundoplication have been introduced and practiced by surgeons with variable outcomes.


METHODS
This modified technique of laparoscopic fundoplication, which we use, is basically a spiral wrap. It is constructed by using several specifically located Ethibond stitches to keep the gastroesophageal junction and a length of the esophagus inside the abdomen without esophageal stitching. Postoperative outcome including patient satisfaction was assessed clinically during follow-up visits. Patients with recurrent symptoms and complications were assessed by appropriate tests. All patients were seen at 6 weeks, 6 months, 12 months, and annually after the operation.


RESULTS
Fifty-seven patients underwent laparoscopic antireflux surgery using the spiral wrap technique. Four patients reported occasional heartburn and only 1 patient developed regurgitation after 1 year from the operation. Nine patients developed early dysphagia and 2 patients had gas bloat syndrome at 6 weeks postoperative assessment. No dysphagia or gas bloat syndrome was confirmed after a year and no revisional surgery was reported.


CONCLUSIONS
Modification of the classic fundoplication to spiral wrap is associated with acceptable morbidity and low incidence of postoperative dysphagia and gas bloat syndrome.
Hussain
Abdulzahra
A
Minimal Access Unit, General Surgery Department, Princess Royal University Hospital, Farnborough Common, Orpington, Greater London, UK. azahrahussain@yahoo.com
Mahmood
Hind
H
Nicholls
Jackie
J
El-Hasani
Shamsi
S
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003680:Deglutition Disorders / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012008:Recurrence; D012189:Retrospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome; D055815:Young Adult