LAPAROSCOPIC PHYSIOLOGICAL ANTIREFLUX PROCEDURE - PRELIMINARY-RESULTSOF A PROSPECTIVE SYMPTOMATIC AND OBJECTIVE STUDY

The 'physiological' antireflux procedure has been shown to be as effec tive as Nissen fundoplication in reflux control, but with a significan t reduction in the incidence of mechanical complications. This techniq ue was attempted laparoscopically in 26 patients in a prospective stud y involving independent symptomatic, manometric and pH assessment perf ormed before operation and at a mean of 5.5 months after operation. Th e procedure was successfully completed laparoscopically in 23 (88 per cent) patients. Mean hospital stay was 3.8 days and mean time to retur n to work 1.8 weeks. There was neither mortality nor reoperation; 91 p er cent of patients obtained symptomatic relief (82 per cent Visick gr ade 1). There was no gas-bloat or inability to belch or vomit. All 14 patients who underwent objective testing had a normal oesophageal pH p rofile, the mean percentage total time that pH<4 falling from 11.0 to 1.1 (P<0.001). Lower oesophageal;sphincter characteristics, including relaxation, were similar to control values. These preliminary results suggest symptomatic and objective results comparable to those followin g open surgery, but with the benefits of a shorter hospital stay and t ime off work. In addition to a lower incidence of mechanical complicat ions, the relative ease of performance of this procedure confers an ad ditional advantage over Nissen fundoplication when performed laparosco pically.