PARTIAL FUNDOPLICATION FOR GASTROESOPHAGEAL REFLUX

Background: About 20% of patients with gastroesophageal reflux disease (GERD) have severely impaired esophageal peristalsis in addition to a n incompetent lower esophageal sphincter. In these patients a total fu ndoplication corrects the abnormal reflux, but it is often associated with postoperative dysphagia and gas bloat syndrome, We studied the ef ficacy of partial fundoplication in such patients. Methods: A partial fundoplication (240 degrees-270 degrees) was performed laparoscopicall y in 26 patients (11 men, 15 women; mean ape 50.5 years) with GERD (me an DeMeester score: 92 +/- 16) in whom manometry demonstrated severely abnormal esophageal peristalsis. Results: All operations were complet ed laparoscopically and the patients were dicharged an average of 39 h after surgery. The preoperative symptoms resolved or improved in all patients, and no patient developed dysphagia or gas bloat syndrome. Po stoperative pH monitoring showed complete or nearly complete resolutio n of the abnormal reflux in every patient. Conclusions: Partial fundop lication is an excellent treatment for patients with GERD and weak per istalsis, for it corrects the abnormal reflux and avoids postoperative dysphagia.