MEDIUM-TERM RESULTS OF LAPAROSCOPIC TREATMENT OF GASTROESOPHAGEAL REFLUX DISEASE BY FUNDOPLICATION

The aim of this study was to see whether the results of surgical treat ment: of gastroesophageal reflux disease (GERD) by laparoscopic fundop lication were satisfactory and stable over time. Patients and I,method s : From July 1992 to September 1996, 161 patients with medical treatm ent-dependent GERD were operated. 17 patients were excluded from the s tudy (conversion or immediate laparotomy). The group of 144 patients i ncluded consisted of 92 men and 52 women with a mean age of 50 (25-77 years). The preoperative work-up included endoscopy, esophageal manome try and 24-hour pH monitoring. The surgical procedures were complete f undoplication without section of the short vessels (Nissen:Rossetti : 122 cases), with section of the shorts vessels (Nissen : 18 cases), or partial fundoplication of 270 degrees (Toupet: 4 cases). The patients were reviewed clinically 3 months after the operation, with repeat ma nometry and pH monitoring; yearly survey was performed. Results.. Ther e was no postoperative mortality. The morbidity consisted of 2 respira tory complications (1.5 %) with good recovery. With a follow-up of 3 a nd 21 months, the dysphagia rate was 24 vs 2 % of patients (p < 0.05), the rate of gas bloat syndrome was 18 % vs 21% (n.s.), and the GERD r ecurrence 6% vs 14 % (p < 0.05), The mean time to recurrence was 8 mon ths. 2 patients were reoperated : one for incisional hernia and one fo r slipped-Nissen. Conclusion : The results of laparoscopic treatment o f GERD with fundoplication procedures at 2 years follow-up showed an 8 6% cure rate of GERD control and 94% satisfaction rate for the patient s who were investigated.