Laparoscopic hiatal herniorrhaphy with posterior fundoplication for gastroesophageal reflux

Complications and side effects following laparoscopic antireflux procedures are common. This article describes an alternative laparoscopic technique t o prevent gastroesophageal reflux. This method consists of posterior approx imation of the diaphragmatic crura followed by a posterior fundoplication o f -270 degrees wrap. In avoiding the 360 degrees wrap and obtaining length from the longitudinal axis of the stomach, it is not necessary to take down the gastrosplenic vessels. The principle of the procedure is to accentuate the cardioesophageal angle of His. No sutures are placed in the esophagus. While this article primarily concerns technique, it also constitutes a bri ef report on the first 50 patients who have been followed up for 1 year or more. All patients but one are free of reflux symptoms and have discontinue d taking all medication. There has been no dysphagia to liquids, and solid food dysphagia has not lasted >1 month. Bloating from gas is minimal, as mo st patients are able to burp early in their recovery. An outcome paper desc ribing preoperative and postoperative objective testing and evaluation is i n process.