A 270 DEGREE LAPAROSCOPIC POSTERIOR FUNDOPLASTY IN THE TREATMENT OF GASTROESOPHAGEAL REFLUX

BACKGROUND: The aim of this prospective study was to evaluate the resu lts of laparoscopic treatment of gastroesophageal reflux using a poste rior fundoplasty. STUDY DESIGN: Fifty-one patients with gastroesophage al reflux or paraesophageal hernia, or both, documented by fibroscopy, acid reflux monitoring and manometry were evaluated, The operative te chnique consisted of abdominal esophagus mobilization, approximation o f the crura, and construction of a 270 degree posterior gastric valve, 5 to 7 cm in height. A clinical examination was performed after two w eeks, four months, one year, and two years, and fibroscopy, acid reflu x monitoring, and manometry were done at four months. RESULTS: One pat ient required a conversion to laparotomy. One opening of the gastric v alve was repaired laparoscopically. There was no perioperative death. Morbidity was limited to one case of pulmonary aspiration of gastric j uice. All patients but one who were operated on laparoscopically have been clinically evaluated between four and six months after surgery, T here was no dysphagia, diarrhea, or gas bloating reported after two mo nths. Four patients without clinical symptoms refused to go through po stoperative explorations, Among the 45 remaining patients, one had a r eflux recurrence and another only an abnormality on acid reflux monito ring, There was no degradation of the clinical result among the 26 and 12 patients seen at one and two years, respectively. CONCLUSIONS: A 2 70 degree posterior fundoplasty can be performed laparoscopically with out major morbidity, A short follow-up examination confirms the effica cy of the procedure and the absence of specific morbidity. If these re sults are confirmed, they could be an argument to broaden the indicati ons of the antireflux procedure as compared to prolonged medical treat ment.