OBJECTIVES: To improve patient’s satisfaction, reduction of post operative dysphagia, and the possibility of using this technique modification in all cases, despite alterations in esophageal motility.
METHODS: Fundoplication was performed with the following features: a) 360º, b) Symmetrical: sutured to the right side of the esophagus, c) Longer: 4 to 5 cm., d) Floppy: calibration up to 68 – 74 Fr gauge, e) Restoring the Angle of His (suturing it to the left side of the esophagus). Previous experience obtained in pig models demonstrated the efficiency and safeness of the technique. The preoperative evaluation for all our patients included the following: complete history and physical examination, upper gastrointestinal contrast study, esophagogastroduodenoscopy with biopsy, esophageal manometry, and 24-hour esophageal pH monitoring. Surgery in all our patients was performed by the same surgeon. A survey to evaluate postoperative dysphagia and satisfaction level was administrated during the follow-up period, as well as postoperative esophagogastroduodenoscopy two months later.
RESULTS: Between January 2000 and December 2006, 252 patients with GERD underwent laparoscopic fundoplication with these technical modifications. 127 patients were excluded from the study because of concomitant surgeries (cholecystectomy, hernia repair, vagotomy, pyloroplasty, gastrectomy, mesh using crural repair). The mean follow-up was 4.14years. There were 88 men (70.4%) and 37 women (29.6%), The mean duration of preoperative symptoms of GERD was 4.1 years.Transient postoperative mild dysphagia was observed in 112 patients (89.6%) that improved without any intervention. Severe dysphagia was observed in 3 patients (2.4%) requiring only one endoscopic dilation. Visick Score I-II was 99.2%.Of the 125 patients, 123 (98.4%) reported that they were satisfied with the result of surgery at 4.14-year follow-up. When asked whether they would have the operation again, 124 (99.2%) answered affirmatively.
CONCLUSIONS: Laparoscopic fundoplication with this modified technique is feasible, safe and effective compared with classical Nissen fundoplication, improves transient postoperative dysphagia and long term patient satisfaction. Controlled multicentric trials to support this technical proposal are still necessary.
Program Number: P271