Performance of a laparoscopic posterior partial
fundoplication (
LPPF) for severe
gastroesophageal reflux disease may have significant advantages. These include a low incidence of postop
dysphagia, maintenance of the ability to belch, excellent antireflux effects, and the ease of performance of the surgery. The purpose of this study was to evaluate this antireflux procedure for these advantages to determine both its safety and effectiveness. Over 200 LPPFs have been performed by the authors in a community setting. One hundred consecutive cases are evaluated for indications, preop, and postop studies (EGD, manometry, 24 h pH), time of operation,
hospital stay, complications, and conversions to an open procedure. Our technique of
LPPF is presented in detail. All patients maintained the ability to belch. Postop
dysphagia resolved totally in 4 patients by 7 days. Four pneumothoraces occurred; 1 patient required bilateral
chest tube placement. There were no esophageal, stomach, or splenic
injuries. The average
hospital stay was 1.6 days. Postop 24 h pH studies revealed resolution of the
esophageal reflux. Postop manometric studies show a median increase of 9.2 mm Hg for the LES pressure. No patients have resumed antireflux medication. No short gastric vessels were divided and no esophageal
sutures were placed. There were no conversions to a
laparotomy. Laparoscopic posterior partial
fundoplication is a safe and effective antireflux procedure.