>Year 2002, Issue 3
Hidalgo CF, Melgoza OC, Hesiquio SR
Nissen-type fundoplication through laparoscopy for the treatment of reflux esophagitis: Analysis of 72 patients
Cir Gen 2002; 24 (3)
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Objective: To analyze retrospectively a group of patients with reflux esophagitis, treated surgically with Nissen-type fundoplication using a laparoscopic approach.
Design: Retrospective, observational, study, without control group.
Setting: Third level health care private hospitals.
Patients and methods: We studied 72 patients in whom peptic esophagitis due to incompetence of the inferior esophageal sphincter had been demonstrated clinically and endoscopically. Criteria to indicate surgery were: persistence of symptoms despite medical treatment, need of high medication doses for prolonged time; grade III or IV esophagitis with complications, such as stenosis, ulceration or Barrett’s esophagus, and persistent respiratory symptoms as chronic laryngitis or recurrent pneumonia. All were subjected to Nissen type fundoplication. Post-operative follow-up was of 6 months to 7 years. We analyzed the following variables: gender, age, symptoms, evolution, surgical time, working performance, morbidity and mortality.
Results: Patients were 53 men (73%) and 19 women (27%). Age ranged from 23 to 74 years; 67% (48) of patients had more than two years of evolution. Regurgitation occurred in 93%, pyrosis in 30%, and dysphagia in 27%, as main esophageal symptoms.
Among those of non-esophagic origin were pharyngeal pain or ardor in 67%, morning hoarseness in 37%, dry cough in 33%, and halitosis in 13%. Endoscopy revealed grade II or III esophagitis in 68% of patients. Esophageal manometry was performed in only 13 patients, in none was the pH metered. Ninetyfive percent of the patients remained in the hospital for 24 hours after surgery and resumed normal activities between 7 to 10 days afterwards. Average surgical time was of 90 minutes. There was a 5% morbidity and 0% mortality.
Conclusion: If gastroesophagic reflux presents without other pathologies, the surgical treatment through laparoscopy using the Nissen technique is effective.
||Gastroesophagic reflux, Peptic esophagitis, antireflux surgery, laparoscopic Nissen fundoplication.
Patti MG, Arcerito M, Feo CV, De Pinto M, Tong J, Gantert W et al. An analysis of operations for gastroesophageal reflux disease: identifying the important technical elements. Arch Surg 1998; 133: 600-6 discussion 606-7.
Dent J, Holloway RH, Toouli J, Dodds WJ. Mechanisms of lower esophageal sphincter incompetence in patients with symptomatic gastroesophageal reflux. Gut 1988; 29: 1020-8.
Mittal RK, Lange RC, McCallum RW. Identification and mechanism of delayed esophageal acid clearance in subjects with hiatus hernia. Gastroenterology 1987; 92: 130-5.
Sloan S, Rademaker AW, Kahrilas PJ. Determinants of gastroesophageal junction incompetence: hiatal hernia, lower esophageal sphincter, or both? Ann Intern Med 1992; 117: 977-82.
Paterson WG, Kolyn DM. Esophageal shortening induced by short term intraluminal acid perfusion in opossum: a cause for hiatus hernia? Gastroenterology 1994; 107: 1736-40.
Melgoza Ortiz C, Hesiquio SR, Lasky MD, Schenk PL, Hidalgo FC. Funduplicatura laparoscópica con trócares de 5 mm. ¿Evita las hernias postincisionales? Cir Gen 2001; 23: 33-5.
Dallemage B, Weerts JM, Jehaes C, Markkiewicz S, Lombart R. Laparoscopic Nissen fundoplication: preliminary report. Surg Laparosc Endosc 1991; 1: 138-43.
An American Gastroenterological Association medical position statement of the clinical use of esophageal manometry. American Gastroenterological Association. Gastroenterology 1994; 107: 1865.
American Gastroenterological Association medical position statement: guidelines on the use of esophageal pH recording. Gastroenterolgy 1996; 110: 1981.
Kahrilas PJ, Clouse RE, Hogan WJ. American Gastroenterological Association technical review on the clinical use of esophageal manometry. Gastroenterology 1994; 107: 1865-84.
>Year 2002, Issue 3