Surgical technique for gastroesophageal reflux disease.

Abstract

AIMS:

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.

CONCLUSION:

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.

• Authors: Jochen Grommes, Marcel Binnebösel, Christian Daniel Klink, Klaus Thilo von Trotha, Karsten Junge, Marc Jansen
• Journal: Journal of investigative surgery : the official journal of the Academy of Surgical Research (J Invest Surg) Vol. 23 Issue 5 Pg. 273-9 (Oct 2010) ISSN: 1521-0553 [Electronic] United States
• PMID: 20874483 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Deglutition Disorders (epidemiology)
• Female
• Fundoplication (adverse effects, methods)
• Gastroesophageal Reflux (surgery)
• Heartburn (epidemiology)
• Humans
• Hydrogen-Ion Concentration
• Male
• Manometry
• Middle Aged
• Prospective Studies