Laparoscopic posterior partial fundoplication for the treatment of gastroesophageal reflux: midterm results.

Study aim: The aim of this study was to report the mid-term results of the surgical management of gastroesophageal reflux disease (GERD) by laparoscop ic posterior partial fundoplication (Toupet technique) in 100 patients, and to evaluate their post-operative quality of life. Patients and method: Between November 1993 and January 2000, 100 patients w ere surgically treated for a medically refractory GERD. Laparoscopic poster ior partial fundoplication was performed by the Toupet technique. In the po stoperative period, the patients were asked to answer a questionaire by tel ephone. The aim of this survey was three-fold: to identify clinical symptom s indicative of recurrence; to evaluate postoperative functional impairment ; to assess the postoperative quality of life. pH monitoring was also propo sed in asymptomatic patients at a minimum follow-up of two years, and in al l patients with clinical symptoms of GERD recurrence. Results: Six laparotomy conversions were necessary. The mean duration of fo llow-up was 18 months (range: 6 to 57 months). The rate of clinically diagn osed recurrence was 7.6%. Intermittent dysphagia was observed in 2.3% of ca ses. Postoperative digestive functional disorders were noted in 53% of pati ents without clinical recurrence, and 95.3% of them were satisfied or very satisfied with the results of surgery. Conclusion: Laparoscopic posterior partial fundoplication by the Toupet tec hnique can satisfactorily treat GERD without mid-term recurrence in about 9 4% of cases. Patient satisfaction seems mainly to depend on the disappearan ce of clinical symptoms of GERD. It was found that postoperative functional disorders frequently occurred, but were well tolerated. Their etiology has not yet been determined, and it is considered that factors other than the surgical procedure may also play a role. (C) 2001 Editions scientifiques et medicales Elsevier SAS.