[Laparoscopic treatment of gastro-oesophageal refflux: a review of 51 cases]

ABSTRACT

The fundoplication to treat gastroesophageal reflux disease have proven themselves in open surgery and are being validated by laparoscopy. The purpose of this retrospectise study was to evaluate the results in the short and medium term treatment of gastroesophageal reflux by laparoscopy in a series of 51 patients and compare our results with those of literature. We report the results of a retrospective study of 51 consecutive patients operated by laparoscopy for gastro-esophageal reflux during the period January 2000 to December 2004. The indication for surgery was the drug resistance [persistence of symptoms of reflux on treatment], drug addiction, persistent esophagitis after a well conducted medical treatment and endobrachy-esophagus. All our patients had a total or partial fundoplication. Our Outcome measures were mortality, morbidity specifically, the conversion rate and functional outcome in the short and medium term. These 24 men and 27 women of average age 38 years [range 17-71 ans].All patients were approached first by laparoscopy. All our patients had a fundoplication 44 total, including 10 with section of short vessels [Nissen] and 34 without section of short vessels [Nissen-Rossetti]. The other 7 patients had a partial posterior fundoplication of 180 degrees. We used the conversion in four patients [7.8%]. Mortality was nil. The specific complications were observed in 2 patients [4%], a case of gastroparesis positive trends in gastric aspiration. A case of aphagie requiring reoperation for postoperative J2 to convert a valve type Nissen-Rossetti valve type Toupet. The non specific complications were dominated by pneumonia in 4 patients [7.8%]. In the medium term, gas bloat syndrome was present in 7.8% of cases. Dysphiagia, present in [77%] cases, was transient in 40 patients [62%] and persistent in 15 patients including 2 requiring dilation sessions. One patient experienced a recurrence of reflux confirmed by pH monitoring. The laparoscopic approach is being validated in the surgical treatment of gastroesophageal reflux. In our series of 51 patients, the results were satisfactory and comparable to those of the literature