BACKGROUND: Complicated gastroesophageal reflux disease (GERD) require
s long-term medical therapy, which in some instances is incompletely e
ffective or poorly tolerated, Additionally, there is concern about the
consequences of prolonged acid suppression therapy, Surgical correcti
on of GERD has been a therapeutic option for decades, With the advent
of video-assisted laparoscopic surgery, antireflux surgery has had a r
esurgence in popularity. PATIENTS AND METHODS: Between October 1992 an
d June 1995, 20 patients who underwent laparoscopic antireflux surgery
were completely studied preoperatively and 3 months postoperatively w
ith 24-hour pH monitoring and esophageal manometry. Follow-up averaged
18 months, The indication for surgery was medically refractory diseas
e in 75%, intolerance to medication in 10%, and concern regarding the
consequences of long-term medical therapy in 15%, Two thirds of these
patients had complicated GERD. RESULTS: Operative time averaged 4 hour
s, There was no conversion to an open procedure, There was no mortalit
y, Two patients had recurrent reflux, for a failure rate of 10%, Overa
ll, postoperative reflux episodes and percent of time pH was less than
4 dropped significantly, Lower esophageal sphincter function showed a
statistically significant increase in mean postoperative resting pres
sure and residual sphincter pressure during swallowing. There was no c
hange in motility postoperatively. CONCLUSIONS: Laparoscopic antireflu
x surgery is a safe, effective, therapeutic alternative in the managem
ent of gastroesophageal reflux disease, (C) 1997 by Excerpta Medica, I
nc.