Lozano-Dubernard GM, Ruíz-López PJ, Lino-Silva LS, Ortiz-Mejía RG, Montoya-Ramírez J, Aguilar-Soto ÓA, López-Gutiérrez J

Language: Spanish
References: 11
Page: 8-15
PDF size: 352.22 Kb.

ABSTRACT

Introduction and objectives: laparoscopic fundoplication involves the dissection of the phrenoesophageal membrane (PEM) and the diaphragmatic transversalis fascia (DTF). We propose modifying this technique by preserving the anatomical structures involved in esophageal fixation to reduce surgical trauma, decrease postoperative pain, dyspeptic syndrome and dysphagia, and evaluate the main outcomes of this technique. Material and methods: a comparative, prospective, observational study was conducted in a private hospital in Mexico City from August 2018 to January 2022, including patients diagnosed with gastroesophageal reflux disease (GERD) due to lower esophageal sphincter (LES) incompetence or hiatal hernia confirmed by endoscopic, radiological, and manometric evaluation. These patients were treated with a modified laparoscopic Nissen procedure that preserved the PEM and DTF and were followed up for one year. The following variables were considered: gender, age, weight, number of surgical sutures in fundoplication, hernia size in centimeters, bleeding, surgical time, comorbidities, ligation of short vessels, length of hospital stay, postoperative pain, and postoperative dysphagia. Results: during the study, 45 patients underwent laparoscopic fundoplication. In 24 patients, the PEM and DTF were preserved, forming the study group. All of these patients had type I hiatal hernia with LES incompetence. The remaining 21 patients did not have the membrane preserved. All patients showed significant improvement in terms of postoperative pain and dysphagia. Conclusions: preservation of the PEM and DTF is a technically feasible and safe modification of the Nissen procedure for type I hiatal hernia, with good results.

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