| Long-term results (6-10 years) of laparoscopic fundoplication. | |
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MedLine Citation:
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PMID: 17619938 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Most papers report excellent results of laparoscopic fundoplication but with relatively short follow-up. Only few studies have a follow-up longer than 5 years. We prospectively collected data of 399 consecutive patients with gastroesophageal reflux disease (GERD) or large paraesophageal/mixed hiatal hernia who underwent laparoscopic fundoplication between January 1992 and June 2005. Preoperative workup included symptoms questionnaire, videoesophagogram, upper endoscopy, manometry, and pH-metry. Postoperative clinical/functional studies were performed at 1, 6, 12 months, and thereafter every other year. Patients were divided into four groups: GERD with nonerosive esophagitis, erosive esophagitis, Barrett's esophagus, and large paraesophageal/mixed hiatal hernia. Surgical failures were considered as follows: (1) recurrence of GERD symptoms or abnormal 24-h pH monitoring; (2) recurrence of endoscopic esophagitis; (3) recurrence of hiatal hernia/slipped fundoplication on endoscopy/barium swallow; (4) postoperative onset of dysphagia; (5) postoperative onset of gas bloating. One hundred and forty-five patients (87 M:58 F) were operated between January 1992 and June 1999: 80 nonerosive esophagitis, 29 erosive esophagitis, 17 Barrett's esophagus, and 19 large paraesophageal/mixed hiatal hernias. At a median follow-up of 97 months, the success rate was 74% for surgery only and 86% for primary surgery and 'complementary' treatments (21 patients: 13 redo surgery and eight endoscopic dilations). Dysphagia and recurrence of reflux were the most frequent causes of failure for nonerosive esophagitis patients; recurrence of hernia was prevalent among patients with large paraesophageal/mixed hiatal hernia. Gas bloating (causing failure) was reported by nonerosive esophagitis patients only. At last follow-up, 115 patients were off 'proton-pump inhibitors'; 30 were still on medications (eight for causes unrelated to GERD). Conclusion confirms that laparoscopic fundoplication provides effective, long-term treatment of gastroesophageal reflux disease. Hernia recurrence and dysphagia are its weak points. |
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Authors:
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Giovanni Zaninotto; Giuseppe Portale; Mario Costantini; Christian Rizzetto; Emanuela Guirroli; Martina Ceolin; Renato Salvador; Sabrina Rampado; Oberdan Prandin; Alberto Ruol; Ermanno Ancona |
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Publication Detail:
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Type: Journal Article Date: 2007-07-10 |
Journal Detail:
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Title: Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract Volume: 11 ISSN: 1091-255X ISO Abbreviation: J. Gastrointest. Surg. Publication Date: 2007 Sep |
Date Detail:
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Created Date: 2007-08-22 Completed Date: 2007-12-06 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9706084 Medline TA: J Gastrointest Surg Country: United States |
Other Details:
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Languages: eng Pagination: 1138-45 Citation Subset: IM |
Affiliation:
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Department of Medical and Surgical Sciences, Clinica Chirurgica III, University of Padova School of Medicine, Via Giustiniani 2, 35128, Padova, Italy. giovanni.zaninotto@unipd.it |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Barrett Esophagus / surgery Disease Progression Female Fundoplication* / methods Gastroesophageal Reflux / surgery* Hernia, Hiatal / surgery Humans Laparoscopy Male Middle Aged Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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