A TAILORED APPROACH TO ANTIREFLUX SURGERY

Tailored surgical antireflux procedures were done in 104 patients duri ng a 7-year period. Presenting symptoms included heartburn in 95 patie nts (91%), regurgitation in 83 patients (80%), and dysphagia in 61 pat ients (60%). Evaluation before operation included video barium esophag ography, endoscopy, 24-hour esophageal pH monitoring, and esophageal m otility studies. On the basis of anatomic and functional findings, the following procedures were performed: 15 laparoscopic and 49 open tran sabdominal Nissen fundoplications, 23 transthoracic Nissen fundoplicat ions, seven Belsey partial fundoplications, and 10 Collis gastroplasty and Belsey partial fundoplications. The severity of symptoms was asse ssed before and after operation according to a previously published gr ading score, Eighty-five of the 104 patients (82%) were able to be con tacted for a follow-up evaluation by means of a standardized questionn aire. Median length of follow-up was 4 years, with 40 patients having follow-up beyond 5 years. The tailored operation cured the symptoms of heartburn in 97%, regurgitation in 91%, and dysphagia in 92%. Ninety- eight percent of the patients reported that operation had cured their preoperative symptoms and 93% were satisfied with the outcome of the o peration. To obtain optimal results, surgical treatment of gastroesoph ageal reflux disease should be tailored to the patient's anatomic and functional assessments. For early, uncomplicated disease a transabdomi nal Nissen fundoplication is done, laparoscopically when expertise exi sts. Patients with complicated disease should undergo an open antirefl ux procedure tailored to specific anatomic or functional abnormalities .