Laparoscopic treatment of gastroesophageal reflux disease. Personal experience

The aim of this paper was to prospectively evaluate immediate and late results of laparoscopic fundoplicature for Gastroesophageal Reflux Disease (GERD). Patients presenting with a GERD having previously had a long-term medical treatment were included; exclusion criteria were represented by controindications to laparoscopy and GERD reoperation surgery. Preoperative evaluation included upper GI tract endoscopy, ecography, esophageal manometry and 24-hour pHmetry. Standard surgical procedure was a Nissen-Rossetti 360-degree fundoplication: short vessel division (Nissen operation) was performed in cases of excessive tension of the wrap and a partial 270-degree fundoplication (Toupet) in cases of motility disorders of the esophagus. Postoperative morbidity and late results were evaluated, with a clinical evaluation at 1, 3, 12 and 22 months and a 3-month manometry and pHmetry. Two hundred and twelve patients were observed, and 201 included: 123 men and 78 women. Nissen-Rossetti fundoplication was performed in 158 cases, Nissen in 23 and Toupet in 10. In 9 patients laparoscopic fundoplication was converted to an open Nissen Rossetti procedure. There was no hospital mortality and three cases of complications: two pneumonia and one gastroplegia. Mean hospital stay was 7 days. At late follow up 94% of patients had a Visick score of I or II, with, however, slight dysphagia (without any modification in alimentary habits) in 25% of cases. Fourteen patients had a relapse or a sporadic relapse of GERD, and two were reoperated on for a slipped Nissen and for a stenosis. On the basis of our experience, laparoscopic fundoplication for GERD is a safe and effective operation, with good long-term functional results: slight sequelae, not affecting quality of life, could, however, be present.