Laparoscopic antireflux surgery in the treatment of gastroesophageal reflux in patients with Barrett esophagus

Background: Patients with gastroesophageal reflux and Barrett esophagus may represent a group of patients with poorer postoperative outcomes. It has b een suggested that such patients should undergo open rather than laparoscop ic antireflux surgery. Hypothesis: The laparoscopic approach to antireflux surgery is appropriate treatment for patients with Barrett esophagus who have symptomatic gastroes ophageal reflux disease. Methods: The outcome Of 757 patients undergoing laparoscopic surgery for ga stroesophageal reflux disease from January 1, 1992, through December 31, 19 98, was prospectively examined. Barrett esophagus was present in 81 (10.7%) Of these patients (58 men and 23 women). The outcome for this group of pat ients was compared with that of patients undergoing surgery who did not hav e Barrett esophagus. Results: The types of operation performed were similar for the 2 patient gr oups. The mean +/-SD length of columnar mucosa was 47.4 +/- 43.6 mm. The av erage +/-SD operation time was 79.0 +/- 33.4 minutes. Conversion to open su rgery occurred in 6 patients. Postoperative outcomes were as follows. Esoph ageal manometry and 24-hour pH studies before and after laparoscopic fundop lication demonstrated a significant increase ill lower esophageal sphincter resting and residual relaxation pressures and a significant decrease in di stal esophageal acid exposure. Four patients have developed high-grade dysp lasia or invasive cancer within 4 years of their antireflux surgery, and al l of these have subsequently undergone esophageal resection. Conclusions: The outcome of laparoscopic antireflux surgery is similar for patients with Barrett esophagus compared with other patients with gastroeso phageal reflux disease. This suggests that laparoscopic surgery is appropri ate treatment for this patient group.