Laparoscopic ‘physiological’ antireflux procedure: Preliminary results of a prospective symptomatic and objective study

British Journal of Surgery - Tập 82 Số 5 - Trang 651-656 - 1995
Angus Watson1, Robert Spychal1, Matt Brown1, N. Peck1, Natalie S. Callander1
1Department of Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia

Tóm tắt

Abstract The ‘physiological’ antireflux procedure has been shown to be as effective as Nissen fundoplication in reflux control, but with a significant reduction in the incidence of mechanical complications. This technique was attempted laparoscopically in 26 patients in a prospective study involving independent symptomatic, manometric and pH assessment performed before operation and at a mean of 5.5 months after operation. The procedure was successfully completed laparoscopically in 23 (88 per cent) patients. Mean hospital stay was 3.8 days and mean time to return to work 1.8 weeks. There was neither mortality nor reoperation; 91 per cent of patients obtained symptomatic relief (82 per cent Visick grade 1). There was no gas-bloat or inability to belch or vomit. All 14 patients who underwent objective testing had a normal oesophageal pH profile, the mean percentage total time that pH < 4 falling from 11.0 to 1.1 (P < 0.001). Lower oesophageal sphincter characteristics, including relaxation, were similar to control values. These preliminary results suggest symptomatic and objective results comparable to those following open surgery, but with the benefits of a shorter hospital stay and time off work. In addition to a lower incidence of mechanical complications, the relative ease of performance of this procedure confers an additional advantage over Nissen fundoplication when performed laparoscopically.

Từ khóa


Tài liệu tham khảo

Dallemagne, 1991, Laparoscopic Nissen fundoplication: preliminary report, Surg Laparosc Endosc, 1, 138

Dallemagne, 1993, Techniques and results of endoscopic fundoplication, Endosc Surg, 1, 72

Falk, 1992, Laparoscopic fundoplication: a preliminary report of the technique and postoperative care, Aust N Z J Surg, 62, 969, 10.1111/j.1445-2197.1992.tb07656.x

Cuschieri, 1993, Multicenter prospective evaluation of laparoscopic antireflux surgery. Preliminary report, Surg Endosc, 7, 505, 10.1007/BF00316690

Donahue, 1977, The modified Nissen fundoplication - reflux prevention without gas bloat, Chir Gastroenterol, 11, 15

DeMeester, 1986, Nissen fundoplication for gastro-oesophageal reflux disease. Evaluation of primary repair in 100 consecutive patients, Ann Surg, 204, 9, 10.1097/00000658-198607000-00002

Leonardi, 1981, Reoperation for complications of the Nissen fundoplication, J Thorac Cardiovasc Surg, 81, 50, 10.1016/S0022-5223(19)37659-7

Beauchamp, 1989, The post-Nissen fundoplication syndrome, Proceedings 4th World Congress International Society for Disease of the Esophagus, 55

Negre, 1983, Post-fundoplication symptoms. Do they restrict the success of Nissen fundoplication?, Ann Surg, 198, 698, 10.1097/00000658-198312000-00005

Watson, 1991, A more physiological alternative to total fundoplication for the surgical correction of resistant gastro-oesophageal reflux, Br J Surg, 78, 1088, 10.1002/bjs.1800780918

Savary, 1983, Pathological Gastro-oesophageal Reflux, 115

Jenkinson, 1986, Dietary guidelines for ambulatory pH recording, Gut, 27, A594-5

Zaninotto, 1988, The lower esophageal sphincter in health and disease, Am J Surg, 155, 104, 10.1016/S0002-9610(88)80266-6

DeMeester, 1975, Evaluation of the Nissen antireflux procedure by esophageal manometry and twenty-four hour pH monitoring, Am J Surg, 129, 94, 10.1016/0002-9610(75)90174-9

Dent, 1982, Incomplete relaxation of the lower esophageal high pressure zone - possible mechanism of action of fundoplication, Gastroenterology, 82, 1042

Siewert, 1991, The options for surgical therapy of reflux oesophagitis, Gullet, 3, 76

DeMeester, 1982, Surgery for esophageal motor disorders, Ann Thorac Surg, 34, 225, 10.1016/S0003-4975(10)62490-3

O'Sullivan, 1982, Interaction of lower esophageal sphincter pressure and length of sphincter in the abdomen as determinants of gastroesophageal competence, Am J Surg, 143, 40, 10.1016/0002-9610(82)90127-1

Mittal, 1988, Electrical and mechanical activity in the human lower esophageal sphincter during diaphragmatic contraction, J ClinInvest, 81, 1182

Skinner, 1985, Pathophysiology of gastroesophageal reflux, Am Surg, 202, 546

Park, 1992, An evaluation of the Watson fundoplication, Proceedings Annual Meeting Association of Surgeons of Great Britain and Ireland, 144

Brand, 1979, Esophageal symptoms, manometry, and histology before and after antireflux surgery: a long-term follow-up study, Gastroenterology, 76, 1393, 10.1016/0016-5085(79)90407-4

O'Hanrahan, 1990, Recurrent reflux and wrap disruption after Nissen fundoplication: detection, incidence and timing, Br J Surg, 77, 545, 10.1002/bjs.1800770526

Thông tin
Thông tin xuất bản

British Journal of Surgery

Tập 82 Số 5

651-656

Thông tin tác giả