Predictive factors for short gastric vessels division during laparoscopic total fundoplication.
OBJECTIVE
to determine clinical variables that can predict the need for division of the short gastric vessels (SGV), based on the gastric fundus tension, assessing postoperative outcomes in patients submitted or not to section of these vessels.


METHODS
we analyzed data from 399 consecutive patients undergoing laparoscopic fundoplication for gastroesophageal reflux disease (GERD). The section of the SGV was performed according to the surgeon evaluation, based on the fundus tension. Patients were divided into two groups: not requiring SGV section (group A) or requiring SGV section (group B).


RESULTS
the section was not necessary in 364 (91%) patients (Group A) and required in 35 (9%) patients (Group B). Group B had proportionally more male patients and higher average height. The endoscopic parameters were worse for Group B, with larger hiatal hernias, greater hernias proportion with more than four centimeters, more intense esophagitis, higher proportion of Barrett's esophagus and long Barrett's esophagus. Male gender and grade IV-V esophagitis were considered independent predictors in the multivariate analysis. Transient dysphagia and GERD symptoms were more common in Group B.


CONCLUSIONS
the division of the short gastric vessels is not required routinely, but male gender and grade IV-V esophagitis are independent predictors of the need for section of these vessels.
Departamento de Cirurgia, Escola Paulista de Medicina, Universidade Federal de São Paulo, SP, BR.
Alexandre Chartuni Pereira
AC
Teixeira
Departamento de Cirurgia, Escola Paulista de Medicina, Universidade Federal de São Paulo, SP, BR.
Fernando Augusto Mardiros
FA
Herbella
Departamento de Cirurgia Geral e Oncológica, Hospital do Servidor Público Estadual de São Paulo, BR.
Adorísio
A
Bonadiman
Departamento de Cirurgia Geral e Oncológica, Hospital do Servidor Público Estadual de São Paulo, BR.
José Francisco de Mattos
JF
Farah
Departamento de Cirurgia, Escola Paulista de Medicina, Universidade Federal de São Paulo, SP, BR.
José Carlos
JC
Del Grande
D005260:Female; D005544:Forecasting; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013270:Stomach / Q000098:blood supply; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures