LAPAROSCOPIC FUNDOPLICATION IN THE TREATMENT OF SEVERE GASTROESOPHAGEAL REFLUX DISEASE - PRELIMINARY-RESULTS OF A PROSPECTIVE TRIAL

To determine the technical feasibility and success of laparoscopic fun doplication in the treatment of severe gastroesophageal reflux disease (GERD), 18 consecutive adult patients were enrolled in a prospective study. All patients had received unsuccessful conservative treatment, were refractory to medical management, or had recurrence of symptoms o f esophagitis after omeprazole therapy. All patients had severe acid r eflux on 24-hour esophageal pH monitoring, endoscopic evidence: of pre vious or ongoing esophagitis, and a defective lower esophageal sphinct er on manometry. Complete (Nissen) fundoplication was done in II and p artial (Toupet) fundoplication in 7 patients; the mean operative time was 183 minutes (range, 120 to 357 minutes). Feeding were initiated on the first postoperative day, and the average length of stay was 2.6 d ays (range, 1 to 6). There were no deaths or conversions to laparotomy . Postoperative morbidity consisted of transient bloating in three pat ients and dysphagia requiring dilatation in four patients. Return to w ork or normal activity averaged 19 days (range, 3 to 28), and 17 patie nts (94%) reported good to excellent results, with a median follow-up of 7 months. Laparoscopic fundoplication is technically feasible and o ffers a sound surgical alternative to patients with refractory GERD, b ut longitudinal follow-up is required to confirm long-term results.