LAPAROSCOPIC ANTIREFLUX SURGERY AND THE THORACIC SURGEON - WHAT NOW

Objective: Minimal invasive antireflux surgery is now a well accepted technique gaining a wide spread popularity. Simultaneously there is a growing tendency to fit all surgical candidates into one single type o f operation, i.e. laparoscopic Nissen antireflux operation. This study evaluates the impact of this new technology on the strategy and pract ice of a major referral centre for antireflux surgery. Methods: An ana lysis was made of indications for the different types of antireflux te chniques performed between July, 1993 and 1995. If on Barium swallow t he gastro-oesophageal (GO) junction proved to be reducible, a laparosc opic approach was proposed, if not, an open transthoracic access was p referred. Results: One hundred and fifteen patients were operated. Fif ty five patients underwent a minimal invasive approach: 49 Nissen (are the total fundoplication) and 3 Lind (are the partial fundoplication) operations through laparoscopy, 3 Belsey Mark IV through video assist ed thoracic surgery (VATS). Sixty patients were treated by open surger y for following reasons: conversion to open surgery in 2 cases, redo s urgery in 15 cases, previous other major abdominal surgery in 12, irre ducible GO junction in 5, paraoesophageal or mixed type hernia in 12, Barrett and or oesophagitis IV in 4, combined antireflux surgery and f eeding gastrostomy in 5, abdominal partial fundoplication by principle in 1, associated motility disorder in 1, combined reflux and gastric ulcer disease in 2, and severe emphysema in 1. In the laparoscopic ser ies reflux control at 1 year post surgery as measured by 24 h pH study in 28 patients was obtained in 89.5%. One patient required a reoperat ion for symptomatic recurrence. Conclusions: (1) Laparoscopic antirefl ux surgery is a feasible and well accepted technique (2) careful study of each individual patient is of paramount importance to choose the c orrect type of operation and access as well. Therefore, fitting every patient into a single type of operation, i.e. laparoscopic Nissen, sho uld be avoided; (3) thoracic surgeons with a major interest in GO refl ux disease should familiarize themselves with laparoscopic antireflux procedures. (C) 1997 Elsevier Science B.V.