Laparoscopic treatment of gastroesophageal reflux disease. Personal experience

This paper represents our five-year experience in laparoscopic antireflux surgery. Seven-ynine patients underwent laparoscopic fundoplication: 32 Nissen, 41 Rossetti, 1 Dor and 5 Toupet. Digestive tract radiography, esophago-duodeno-gastroscopy, esophageal manometry and 24-hour Ph monitoring were performed during preoperative evaluation. Some patients also underwent scyntigraphy. During endoscopy stage I esophagitis was found in 27 patients (34%), stage II in 7 patients (9%), stage III in 3 patients (4%), Barrett's in 10 patients (13%); 32 patients (40%) were affected with gastroesophageal reflux disease without esophagitis. Our follow-up showed two complications (2.5%) that were reoperated. One month after surgery 17 patients (21%) showed dysphagia. Eleven (13.3%) had undergone Rossetti procedure and 6 (7.5%) Nissen's. Six months later, 13 patients (16%) were still symptomatic - 4 who underwent Nissen (5%) and 9 Rossetti (11%) procedures. Results showed one hiatal hernia recurrence, without reflux, after the Toupet procedure. Long-term follow-up mean 32 months (range 12 to 50) on 60 patients showed 58 patients Visick I (96%), 1 Visick II (2%) and 1 Visick III (2%). We are convinced that the laparoscopic approach to the esophago-gastric junction is better and provides a more detailed view than open surgery. The problem lies in the indication and choice of the right procedure to perform.