Laparoscopic fundoplication for gastro-esophageal reflux disease: An 8 year experience

Abstract

BACKGROUND:Laparoscopic fundoplication (LF) has become the operation of choice for patients who need surgery for gastro esophageal reflux disease (GERD). Several studies have shown that the long-term results with surgery for GERD are better than medical therapy. In this retrospective study, we outline our experience with LF over an 8 year period. We analyzed factors that would affect the results of surgery and help in a better selection of patients for the operation.MATERIALS AND METHODS:From 1999 to 2007, 107 patients underwent a LF. Eighty five patients had surgery for GERD and form the basis of this article. The other 22 patients had paraesophageal hernias and were excluded from the study. Pre-operative evaluation consisted of endoscopy, a barium study, esophageal manometry and 24h pH monitoring. Patients were followed up every 3rd month for the 1st year, twice in the 2nd year and then annually. Follow up was by personal interview or telephonic conversation. At the last follow up the results of surgery were graded as good or poor as per a scoring system. Those with a poor result were evaluated and re-operation advised when an anatomical problem caused the poor result. Subjective, objective and technical variables were analyzed which could affect the outcome of surgery.RESULTS:In 84 patients, the operation was completed by laparoscopic access. One patient with bleeding was converted to open surgery. There were 5 intra-operative complications; 3 pnemothoracis, 1 esophageal perforation and 1 gastric fundus perforation. There was no mortality. Two patients underwent re-operation, 1 for delayed gastric emptying and 1 for dysphagia. Seventy four patients have been followed up from 7 months to 8 years. Eleven have been lost to follow up. Fifty seven patients (77%) have had a good result from surgery. Seventeen (23%) had a poor result; of these there were 4 wrap failures, 1 delayed gastric emptying and 1 excessive gas bloat as the cause. In 11 patients, there was no apparent cause of a poor result. Individual variables which predicted a good response to surgery (P<0.5); were a good response to proton pump inhibitors (PPis), volume reflux and a pH score of more than 14.CONCLUSION:LF gives good long-term relief of symptoms in patients with GERD. Strict selection criteria are necessary to optimize the results of surgery. Poor selection will result in a patient who is no better, or often worse than before surgery.

Reflux and sex

“…The majority of reports originated in Europe (n = 83) and North America (n = 55) [121,. The remaining series originated in Australia or New Zealand (n = 11) [290][291][292][293][294][295][296][297][298][299][300], Asia (n = 8) [301][302][303][304][305][306][307][308], Africa or the Arab peninsula (n = 3) [309][310][311] or South America (n = 2) [312,313]. Overall, the case series reported a male predominance with women accounting for 46.2 ± 0.9% (range: 30.3-91.0%; P < 0.01) of the patients.…”

Gastroesophageal Reflux Disease: Medical or Surgical Treatment?

“…However, other authors report modest results after laparoscopic antireflux surgery. Balsara et al [ 166 ] from India analyzed retrospectively their experience with laparoscopic fundoplication over an 8-year period. This operation was performed in 84 patients, and 74 of them had been followed up for a period of 7 months to 8 years.…”

The Impact of Laparoscopic Nissen Fundoplication on the Long-Term Quality of Life in Patients With Gastroesophageal Reflux Disease

“…Furthermore, symptoms such as early satiety, dysphagia, and eructation have been reduced according to earlier reports ( Balsara, Shah, & Hussain, 2008 ;Baraket et al, 2009 ;Martinez, Gonzalez, Punal Rodriguez, & Bustamante Montalvo, 2011 ;Nessen, Holcomb, Tankinson, Hetz, & Schreiber, 1999 ;Sato et al, 2002 ;Servio, de Camargo Pereira, & Cataneo, 2012 ;Singhal et al, 2009 ). In the follow-up, 50% (N = 13) of our patients did not have flatulence and only 21.7% (N = 10) of the patients had this symptom quite often.…”