The modern way to prevent complications in laparoscopic antireflux surgery

Abstract

Aim. To improve the results of surgery on patients with hiatus hernia. Methods. Case histories of patients who underwent surgeries at the department of gastric and esophageal surgery from 1996 to 2011 were analyzed. 626 laparoscopic fundoplications in patients aged form 15 to 78 years were performed, among them - 57 using transillumination with fiber optic sensor tube. All patients were present with signs typical for hiatus hernia and gastroesophageal reflux disease (heartburn, belching, early satiety, epigastric discomfort etc.). Pre-surgical examination included X-ray and esophagogastroduodenoscopy. Most patients underwent Nissen fundoplication. The surgery duration varied from 30 to 180 minutes (mean time 65 minutes). Results. Surgical complications such as hollow organs perforation were registered in 4,3% of cases (27 cases out of 626 surgeries). No such complications were registered in group where surgery was performed using transillumination with fiber optic sensor tube. In 12 cases laparotomy for perforation closure was required, in other 15 cases perforation was closed using laparoscopy. No serious events were registered in early post-surgical period, with all patients discharged from the hospital at days 5-7. Such complications as dysphagia and gas-bloat syndrome were predominant in early post-surgical period after laparoscopic fundoplication. The incidence of the early post-surgical complications in patients who underwent surgery without transillumination with fiber optic sensor tube was: dysphagia - 28,8% (164 out of 569 patients), gas-bloat syndrome - 23,7% (135 patients). In cases when transillumination with fiber optic sensor tube was used, dysphagia was diagnosed in 1 case (1,8%), gas-bloat syndrome - in 9 (15,8%) cases. The incidence of late post-surgical complications including dysphagia, relapses and situations when fundoplication becomes undone over time: without transillumination with fiber optic sensor tube - 10,2% (58 out of 569 patients), using transillumination with fiber optic sensor tube - 3,5% (2 out of 57 patients). Conclusion. Preliminary results show that using transillumination with fiber optic sensor tube in laparoscopic fundoplication in patients with hiatus hernia reduces the incidence of post-surgical complications.