Abstract | BACKGROUND: We describe a novel laparoscopic "clam shell" partial fundoplication, incorporating a modified Toupet with an anterior fundic flap for the management of medically recalcitrant gastroesophageal reflux disease. We hypothesize that this clam-shell-like mechanism allows a dynamic rather than rigid circumferential antireflux barrier allowing effective reflux control (compared with partial fundoplication) with reduced occurrence of postoperative dysphagia, gas bloating and vagal nerve injury (compared with Nissen fundoplication). METHODS: RESULTS: There was no mortality or conversions to open procedures. Mean operative time was 45 minutes; median hospital stay was 1 day (range, 1 to 4). Overall control of reflux symptoms was seen in 95% of patients. Postoperative gas bloating and significant dysphagia occurred in only 11% and 6% of patients, respectively. Three patients (2%) experienced postoperative complications ( pneumonia, 2; pleural effusion requiring drainage, 1). Postoperative studies demonstrated reflux in 8 patients (5%) and the presence of small hiatal hernias in 5 patients (4%) during a mean follow-up 19 months (range, 7 to 42). Twenty five patients (17%) underwent postoperative esophageal dilation (median dilations, 1; range, 1 to 3) for dysphagia (11 of these patients had preoperative esophageal dysmotility). Five patients underwent repeat fundoplication (recurrent reflux, 2; gas bloating, 1; dysphagia, 2). CONCLUSIONS: Clam shell near-circumferential fundoplication may be considered as an attractive alternative antireflux approach to Nissen fundoplication, particularly among patients at risk for postoperative dysphagia or gas bloating.
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Authors | Amgad E el-Sherif, Prasad S Adusumilli, Brian L Pettiford, Thomas A d'Amato, Matthew J Schuchert, Alicia Clark, Carmen DiRenzo, Joshua P Landreneau, James D Luketich, Rodney J Landreneau |
Journal | The Annals of thoracic surgery
(Ann Thorac Surg)
Vol. 84
Issue 5
Pg. 1704-9
(Nov 2007)
ISSN: 1552-6259 [Electronic] Netherlands |
PMID | 17954090
(Publication Type: Journal Article)
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Topics |
- Deglutition Disorders
(prevention & control)
- Female
- Flatulence
(prevention & control)
- Fundoplication
(methods)
- Gastroesophageal Reflux
(surgery)
- Humans
- Laparoscopy
(methods)
- Male
- Middle Aged
- Postoperative Complications
(prevention & control)
- Retrospective Studies
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