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>Journals >Cirugía y Cirujanos >Year 2001, Issue 2


Zacate-Otero T, Montiel-Jarquin A, Salazar-Ibarguen J, López-Colombo A
Complications of antireflux surgery during 1998 (IMSS)
Cir Cir 2001; 69 (2)

Language: Español
References: 16
Page: 57-61
PDF: 93.21 Kb.


Full text




ABSTRACT

In 1956, Nissen described for the first time the technique that bears his name, which consists of a fundoplication using the posterior surface of the fundus around the distal oesophagus. In 1965, Nissen and Rosetti proposed a modification that consisted of fundoplication using the anterior surface of the stomach; however, the modifications took place only when it was possible to understand the physiology of the competency of the cardia. Antireflux surgery has made great advances in recent decades but despite this, complications have continued. Objectives: To review the records of all patients having antireflux surgery with Nissen technique in the Hospital de Especialidades del Centro Médico Nacional “M. Avila Camacho” during 1998, with the goal of evaluating complications, studying such variables as age, gender, type of complication, and when it occurred. Results: During the study period, there were 55 antireflux procedures performed: Nissen, 49 (89%), Nissen Rosetti, two (3.8%), and Toupet, four (7.2%). Of these, complications of Nissen technique were studied because of the more significant number of procedures; for this reason, they were divided into transoperatories, three, one perforated oesophagus, one perforated fundus, and one splenectomy, and post-operatives which were eventration in four patients, and one acute gastric distension, all surgically repaired. Secondary symptoms of the surgery occurred as follows: Dysphagia, 13 (26.53%), gastric distension, three (6.12%), inability to belch and vomit, four (8.16%), epigastric pain, five (10.20%), and distension and flatulence, nine (18.36%); in no case did reflux recur (0%). Two patients (4.08%) died, from mediastinitis and septic shock. In 25 patients (51.02%) antireflux effect was immediate and there were no further symptoms. Six months after surgery, 96% of patients had no evidence of reflux. Conclusions: We concluded that despite advances in surgical techniques, there continue to be complications in antireflux procedures; we must carry out a complete preoperation protocol including studies such as oesophagus-stomach-duodenum series, manometry of the oesophagus, 24-h pH measurement, endoscopy, radionuclide studies, endosonograph, and computed tomography to evaluate the anatomy and physiology of the region and based on this, to decide on the appropriate procedure. Additionally, we must see that our complications are within the ranges reported by other authors, that it is necessary to identify earlier serious complications to avoid death, and that it is necessary to perform an endoscopy 6 months after the procedure.


Key words: , Antireflux surgery, Complications.


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>Journals >Cirugía y Cirujanos >Year 2001, Issue 2
 

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