MINIMALLY INVASIVE SURGERY FOR GASTROESOPHAGEAL REFLUX DISEASE

BACKGROUND: The goal of this study was to determine if the outcome of antireflux surgery can be improved by: (1) conducting a careful preope rative workup to characterize gastroesophageal reflux disease (GERD) i n the individual patient; and (2) tailoring the operation to the resul ts of the preoperative function tests. PATIENTS AND METHODS: Sixty-eig ht patients had operations for GERD by minimally invasive techniques. RESULTS: A Rossetti fundoplication was performed in 22 patients. Sixty -eight percent became asymptomatic. Twenty-seven percent developed dys phagia or gas bloat. Thirty-five patients had a Nissen fundoplication. Ninety-one percent are asymptomatic. Eleven patients with severe abno rmalities of esophageal peristalsis underwent a Guarner fundoplication with relief of symptoms in 82% of patients. No patients in the Nissen or Guarner group developed postoperative persistent dysphagia or gas bloat. A pyloromyotomy was performed in 3 patients because of severe d elayed gastric emptying. CONCLUSIONS: Minimally invasive surgery for G ERD gives good-to-excellent results even in patients with abnormal eso phageal body function, provided that the operation is tailored to the individual patient based on the results of the preoperative function t ests.