A prospective multicenter study on laparoscopic treatment of gastroesophageal reflux disease in Italy - Type of surgery, conversions, complications, and early results

Background: A national survey was undertaken by the Italian Society for Lap aroscopic Surgery to investigate the prevalence, indications, conversion ra te, mortality, morbidity, and early results of laparoscopic antireflux surg ery. Methods: Beginning on January 1, 1996, all of the centers taking part in th is study were asked to complete a questionnaire on each patient. The questi onnaire was divided into four parts and covered such areas as indications f or surgery and preoperative workup, type of operation performed and certain aspects of the surgical technique, conversions and their causes, intraoper ative and postoperative complications (within 4 weeks), and details of the postoperative course. The last part of the questionnaire focused on the fol low-up period and was designed to gather data on recurrence of preoperative symptoms, postoperative symptoms (dysphagia, gas bloat), and postoperative test findings. Results: As of June 30 1998, 21 centers were taking part in the study and 6 21 patients were enrolled, with a median of 27 patients per center (less th an one patient/month). The most popular technique was the Nissen-Rossetti ( 52%), followed by the Nissen (33%) and Toupet procedures (13%). Other techn iques, such as the Dor and Lortat-Jacob, were used in the remainder of case s. Patients who received a Toupet procedure had a higher incidence of defec tive peristalsis (p < 0.05). The conversion rate to open surgery was 2.9%. The most common causes of conversion were inability to reduce the hiatus he rnia or distal esophagus in the abdomen and adhesions from previous surgery . Perforation of the stomach and esophagus occurred in <1% of patients. Mor tality was nil. Postoperative complications were observed in 7.3% of eases. The most common complication was acute dysphagia (19 patients), which requ ired reoperation in 10 patients. No differences in the incidence of acute d ysphagia were found for the different surgical techniques employed. Follow- up data were obtained For 319 patients (53%): 91.5% of the patients remaine d GERD symptom-free; severe esophagitis (grade 2-3) healed in 95% of the pa tients: lower esophageal sphincter (LES) manometric characteristics (pressu re, abdominal length, and overall length) improved significantly after surg ery (p < 0.005); and acid exposure of the distal esophagus decreased. Conclusions: Laparoscopic antireflux surgery has no mortality and a low mor bidity. Symptoms and esophagitis are resolved in >90% of patients. Despite these favorable re suits, however, this type of surgery is not yet as widel y employed in Italy as in other countries.