title: Laparoscopic Nissen-Rossetti fundoplication is a safe and effective treatment for both Acid and bile gastroesophageal reflux in patients poorly responsive to proton pump inhibitor.
abstract: OBJECTIVE
  The aim of this study was to evaluate the effectiveness of laparoscopic Nissen-Rossetti fundoplication in patients with gastroesophageal reflux disease (GERD) poorly responsive to standard dose proton pump inhibitor (PPI) therapy.
  
  
  METHODS
  A total of 35 patients (19 women, 16 men, mean age 44.6 ± 14.01 years) were enrolled. All the patients underwent symptom questionnaires, upper gastrointestinal endoscopy, esophageal manometry, and combined 24-hour esophageal pH and bilirubin monitoring. Following this, the patients with persistent pathological esophageal acid and/or bilirubin exposure underwent laparoscopic antireflux surgery, followed by clinical and instrumental 12-month follow-up.
  
  
  RESULTS
  One year after surgery, there was a significant improvement of symptom score, compared with standard PPI dose period (3.54 ± 1.67 vs 20.8 ± 10.9, P < .0001; paired t test) and mean percentage total time acid and bile exposure showed a significant decrease (4.9 ± 2.9 vs 2.03 ± 0.74 and 8.3 ± 3.03 vs 0.84 ± 0.56, P < .0001; paired t test).
  
  
  CONCLUSIONS
  In patients with GERD poorly responsive to standard PPI dose, laparoscopic Nissen-Rossetti fundoplication appears to be a safe and effective treatment of symptoms, esophageal damage, as well as both acid and bile reflux.
authors: School of Medicine, I Policlinico, Second University of Naples, Naples, Italy. antonio_brillantino@libero.it
authors: Antonio
authors: A
authors: Brillantino
authors: Michele
authors: M
authors: Schettino
authors: Francesco
authors: F
authors: Torelli
authors: Luigi
authors: L
authors: Marano
authors: Raffaele
authors: R
authors: Porfidia
authors: Gianmarco
authors: G
authors: Reda
authors: Michele
authors: M
authors: Grassia
authors: Bartolomeo
authors: B
authors: Braccio
authors: Natale
authors: N
authors: Di Martino
mesh_terms: D000328:Adult; D015331:Cohort Studies; D050782:Esophageal pH Monitoring; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D054328:Proton Pump Inhibitors