Document Detail


Long-term results (6-10 years) of laparoscopic fundoplication.
MedLine Citation:
PMID:  17619938     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
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:
Type:  Journal Article     Date:  2007-07-10
Journal Detail:
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:
Created Date:  2007-08-22     Completed Date:  2007-12-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9706084     Medline TA:  J Gastrointest Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1138-45     Citation Subset:  IM    
Affiliation:
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
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MeSH Terms
Descriptor/Qualifier:
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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