Surgical technique for gastroesophageal reflux disease.
OBJECTIVE
Laparoscopic fundoplication is the standard surgical therapy for managing gastroesophageal reflux disease. According to the pre-existing esophageal motility of the patient, tailoring antireflux surgery has been proposed in order to avoid postoperative dysphagia. Thus, the aim of this study is to evaluate the long-term results following this tailored concept.


METHODS
One-hundred sixty patients were included in this prospective study. A 360° Nissen fundoplication (NF) was performed on n = 127 patients with a normal esophageal peristalsis, whereas a 270° Toupet fundoplication (TF) was conducted on n = 33 patients having an esophageal motility disorder. Before surgery, all the patients were subjected to pH-metry, manometry, gastroscopy, and they had to respond to a standardized questionnaire. Postoperatively, pH-metry, and manometry were performed. In addition to the questionnaire, side effects and complications were evaluated.


RESULTS
The NF cohort and the TF cohort were each followed up for an average of 39 ± 13 months and 43 ± 12 months, respectively. Dysphagia was significantly reduced after NF (p = .033). The TF, however, decreased the intensity but not the incidence of dysphagia (p = .884). Heartburn was significantly diminished in both cohorts. The DeMeester score was significantly reduced after NF, whereas it was not significantly reduced following TF with a still evident, pathological acid reflux occurring postoperatively.


CONCLUSIONS
Our data indicate that tailoring antireflux surgery to the esophageal motility of the patient seems unnecessary. In summary, technical surgical aspects appear to be more important for clinical outcome.
Grommes
Jochen
J
Department of Vascular Surgery, RWTH Aachen University Hospital, Germany. jgrommes@ukaachen.de
Binnebösel
Marcel
M
Klink
Christian Daniel
CD
von Trotha
Klaus Thilo
KT
Junge
Karsten
K
Jansen
Marc
M
D000328:Adult; D000368:Aged; D003680:Deglutition Disorders / Q000453:epidemiology; D005260:Female; D018662:Fundoplication / Q000009:adverse effects / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006356:Heartburn / Q000453:epidemiology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011446:Prospective Studies