Gómez CX, Flores AJH, Di Martino AE, Guarneros ZJE, Cervera SA, Ochoa GR, Quijano OF

Language: Spanish
References: 14
Page: 121-126
PDF size: 60.71 Kb.

ABSTRACT

Laparoscopic fundoplication remains a good option for surgical treatment of gastroesophageal reflux disease, offering encouraging results. Objective: To evaluate long-term clinical results of laparoscopic Nissen-Rossetti and Toupet fundoplication, in the treatment of pathologic gastroesophageal reflux for patients treated in Centro Medico ABC. Material and methods: We carried out a retrospective, longitudinal, and observational study of 147 laparoscopic fundoplications in Centro Medico ABC, with an average 3-year clinical follow-up. We compared reflux control, symptomatology associated with the procedure, satisfaction, modified Visick scale, factors associated with reoperation, morbidity and mortality. Qualitative analysis; Chi-square at p < 0.05. Results: 147 laparoscopic fundoplications were included between January and December of 1998. 58% (n = 84) corresponded to Nissen-Rossetti fundoplications and 42% (n = 63) to Toupet, 73% males and 27% females, with an average age of 40 years. 68% of the patients (n = 100) were contacted during the 3-year clinical follow-up. Control of reflux symptoms was 89% and 77.5% for each group p < 0.05. Of the three patients (5%) with persistent dysphagia from the Nissen-Rossetti group, one was dilated and two reoperated p < 0.05. Nine patients (22.5%) of the Toupet group persisted with some degree of heartburn, and continued with intermittent medical treatment, with four patients (10%) required a reoperation p < 0.05. The results of the surgery were excellent and good in 80% in the Nissen-Rossetti group, 3.3% were unsatisfied for severe dysphagia and required reoperation. In the other hand, in the Toupet group the satisfaction were qualified excellent and good in 77.5%, 10% are unsatisfied because they required a new antireflux procedure. Morbidity reached 4 %, with no operative mortality. Conclusion: Long-term control of pathologic gastroesophageal reflux by the laparoscopic fundoplication is similar to the published results in the world-wide literature; with more severe dysphagia in the patients operated with the Nissen-Rossetti technique. In the other hand, in the Toupet group we observed more reoperations and intermittent medical treatment for recurrence of symptoms.

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