Surgery for gastroesophageal reflux disease: a comparative study between the open and laparoscopic approaches.

OBJECTIVE: Given the demonstrated effectiveness of medical treatment together with the eminent acceptance of the laparoscopic approach, the indications of surgery in the treatment of gastroesophageal reflux disease (GERD) are currently subject to continuous controversy. To participate in this debate, we have the following work hypothesis: "The results of the 360 masculine short and floppy laparoscopic fundoplication are superior to those of open surgery". CLINICAL DESIGN: Prospective, clinical, non-randomized study. PATIENTS: Our work was developed between November 1991 and December 1998 by means of a prospective, non-randomized clinical rehearsal with two groups of patients: Group I (n = 75): 360 degree short and floppy laparoscopic fundoplication in Hospital Dr. Peset, Valencia (Spain). Group II (n = 28): 360 degree short and floppy, open fundoplication in Hospital General, Valencia (Spain). We evaluated the preoperative parameters and found no differences, which allows us to know that both groups were comparable. RESULTS: The analysis of peroperative results (morbidity and surgical time) and of clinical follow-up (every three months and later annually) and instrumental follow-up (TEGD, upper digestive endoscopy, pHmetry and manometry) show no differences, while the postoperative analysis shows statistically significant (s.s.) differences regarding recovery (pain, oral intake, hospital stay and return to previous activities). CONCLUSIONS: The results of the 360 degree short and floppy laparoscopic fundoplication are similar to those of the open approach, but favor the former approach with a better postoperative tolerance.

Cirugía de la enfermedad por reflujo gastroesofágico: estudio comparativo entre los abordajes abierto y laparoscópico / Surgery for gastroesophageal reflux disease: a comparative study between the open and laparoscopic approaches

Objetivo: en la actualidad, dada la efectividad demostrada del tratamiento médico junto con la eminente aceptación del abordaje laparoscópico, las indicaciones de la cirugía en el tratamiento de la enfermedad por reflujo gastroesofágico son causa de continua controversia. Para participar en este debate, nos planteamos la siguiente hipótesis de trabajo: "Los resultados de la funduplicatura de 360° corta y holgada por vía laparoscópica son superiores a los de la vía abierta". Diseño clínico: estudio clínico prospectivo no aleatorizado. Pacientes: el trabajo se desarrolló entre noviembre de 1991 y diciembre de 1998, mediante un ensayo clínico prospectivo no aleatorio de dos grupos de pacientes: -Grupo I (n = 75): funduplicatura de 360°, corta y holgada por laparoscopia en el Hospital Universitario Dr. Peset de Valencia. -Grupo II (n = 28): funduplicatura 360°, corta y holgada por vía abierta en el Hospital General Universitario de Valencia. Comparamos, sin hallar diferencias, los parámetros preoperatorios lo que nos permite conocer que los dos grupos son homologables. Resultados: el análisis de los resultados peroperatorios (morbilidad y tiempo quirúrgico) y del seguimiento clínico (a los tres meses y posteriormente de forma anual) e instrumental (TEGD, endoscopia digestiva alta, pHmetría y manometría) no demuestran diferencias; mientras que en el postoperatorio inmediato existen diferencias estadísticamente significativas (e.s.) en lo referente a la recuperación (dolor, tolerancia, estancia y reincorporación a las actividades previas). Conclusiones: los resultados de la funduplicatura de 360° corta y holgada por vía laparoscópica son similares a los de la vía abierta, beneficiándose la primera de una mejor tolerancia postoperatoria

Objective: given the demonstrated effectiveness of medical treatment together with the eminent acceptance of the laparoscopic approach, the indications of surgery in the treatment of gastroesophageal reflux disease (GERD) are currently subject to continuous controversy. To participate in this debate, we have the following work hypothesis: "The results of the 360º short and floppy laparoscopic fundoplication are superior to those of open surgery". Clinical design: prospective, clinical, non-randomized study. Patients: our work was developed between November 1991 and December 1998 by means of a prospective, non-randomized clinical rehearsal with two groups of patients: -Group I (n = 75): 360° short and floppy laparoscopic fundoplication in Hospital Dr. Peset, Valencia (Spain). -Group II (n = 28): 360° short and floppy, open fundoplication in Hospital General, Valencia (Spain). We evaluated the preoperative parameters and found no differences, which allows us to know that both groups were comparable. Results: the analysis of peroperative results (morbidity and surgical time) and of clinical follow-up (every three months and later annually) and instrumental follow-up (TEGD, upper digestive endoscopy, pHmetry and manometry) show no differences, while the postoperative analysis shows statistically significant (s.s.) differences regarding recovery (pain, oral intake, hospital stay and return to previous activities). Conclusions: the results of the 360° short and floppy laparoscopic fundoplication are similar to those of the open approach, but favor the former approach with a better postoperative tolerance