LAPAROSCOPIC TREATMENT OF GASTRO-OESOPHAGEAL REFFLUX: A REVIEW OF 51 CASES

##plugins.themes.academic_pro.article.sidebar##

Published Dec 2, 2009
Download
pdf
Vol. 87 No. 8 (2009): Issue Aug 2009

##plugins.themes.academic_pro.article.main##

Oussama Baraket
Mahmoud El Ajmi
Haikel Rezgui
Faycel El Kateb
Adnen Chouchene
Hassen Khouni
Hedi Balti

Abstract

Background : The fundoplication to treat gastroesophageal reflux disease have proven themselves in open surgery and are being validated by laparoscopy.
But : The purpose of this retrospective study was to evaluate the results in the short and medium term treatment of gastroesophageal reflux by laparoscopy in a series of 51 patients and compare our results with those of literature.
Méthodes : We report the results of a retrospective study of 51 consecutive patients operated by laparoscopy for gastro-esophageal reflux during the period January 2000 to December 2004. The indication for surgery was the drug resistance (persistence of symptoms of reflux on treatment), drug addiction, persistent esophagitis after a well conducted medical treatment and endobrachy- esophagus. All our patients had a total or partial fundoplication. Our outcome measures were mortality, morbidity,
specifically, the conversion rate and functional outcome in the short and medium term.
Résultats : These 24 men and 27 women of average age 38 years (range: 17-71ans). All patients were approached first by laparoscopy. All our patients had a fundoplication: 44 total, including 10 with section of short vessels (Nissen) and 34 without section of short vessels (Nissen-Rossetti). The other 7 patients had a partial posterior fundoplication of 180 degrees. We used the conversion in four patients (7.8%). Mortality was nil. The specific complications were observed in 2 patients (4%), a case of gastroparesis positive trends in gastric aspiration. A case of aphagie requiring reoperation for postoperative J2 to convert a valve type Nissen-Rossetti valve type
Toupet. The non-specific complications were dominated by pneumonia in 4 patients (7.8%). In the medium term, gas bloat syndrome was present in 7.8% of cases. Dysphagia, present in (77%) cases, was transient in 40 patients (62%) and persistent in 15 patients including 2 requiring dilation sessions. One patient experienced a
recurrence of reflux confirmed by pH monitoring.
Conclusion : the laparoscopic approach is being validated in the surgical treatment of gastroesophageal reflux. In our series of 51 patients, the results were satisfactory and comparable to those of the literature.

Keywords:

Gastro-esophageal reflux, Laparoscopic,

##plugins.themes.academic_pro.article.details##

References

  1. K. Slim, J.P. Triboulet. Quel type de fundoplicature pour un reflux gastrooesophagien pathologique. Ann chir. 2003 ; 128 : 40-42
  2. Arnaud JP, Pessaux P, Ghavami B, Flament JB, Trebuchet G, Meyer C, et al. Fundoplicature laparoscopique dans le traitement du RGO. Étude multicentrique sur 1470 cas. Chirurgie 1999; 124:516-22.
  3. Watson DI, Jamieson GG, Baigrie RJ et al. Laparoscopic surgery for gastroesophageal reflux: beyond the learning curve. Br J Surg 1996; 83:1284-7.
  4. S. Dan, C. Brigand, F. Pierrard, S. Rohr, C. Meyer. Les résultats à long terme de la fundoplicature par laparoscopie dans le traitement du reflux gastro-oesophagien. Ann chir 2005 ; 130 : 477-82
  5. Zaouche A, Balti H et al. traitement coelio-chirurgical du reflux gastrooesophagien. Rapport présenté au IIème congrès de la STCL. Mai 2003
  6. Deschamps C, Allen MS, Trastek VF, Johnson JO, Pairolero PC. Early experience and learning curve associated with laparoscopic Nissen fundoplication. J Thorac Cardiovasc Surg 1998;115:281-4.
  7. Chimplaut G. reflux gastro-oesophagien traitement par laparoscopie.940 cas expérience française. Ann Chir 1994 ; 48 : 159-64
  8. Granderath FA, Kamolz T, Schweiger UM, Pointner R. Quality of life, surgical outcome and patient satisfaction three years after laparoscopic Nissen fundoplication. World J Surg 2002;26:1234-8.
  9. F. Bretagnol, B. Giraudeau, P. Bourlier, O. Gandet, L. de Calan. Fundoplicature laparoscopique pour reflux gastro-oesophagien : étude rétrospective des résultats fonctionnels chez 243 patients Ann Chir 2002; 127 : 181-8
  10. Jobe BA,Wallace J, Hansen PD, Swanstrom LL. Evaluation of laparoscopic Toupet fundoplication as a primary repair for all patients with medically resistant gastroesophageal reflux. Surg Endosc 1997 ; 11: 1080-3
  11. Meyer C, Firtion O, Rohr S, De Manzini N, Vo Huten J, Thiry LC. Résultats de la fundoplicature par voie laparoscopique dans le traitement du reflux gastro-oesophagien : À propos de 224 cas. Chirurgie 1998 ; 123 : 257-62.
  12. Dallemagne B, Weerts JM, Jeahes C, Markiewicz S. Results of laparoscopic Nissen fundoplication. Hepatogastroenterology 1998;45: 1338-43
  13. Watson DI, Jamieson GG, Pike GK, Davies N, Richardson M, Devitt PG. Prospective randomized double-blind trial between laparoscopic Nissen fundoplication and anterior partial fundoplication. Br J Surg 1999;86:123-30
  14. Catarci M, Gentleschi P, Papi C, Carrara A, Mareese R, Gaspari AL, Grassi GB. Evidence -based appraisal of antireflux fundoplication. Ann surg 2004; 239:325-37
  15. O'Boyle CJ, Watson DI, Jamieson GG, Myers JC, Game PA, Devitt PG. Division of short gastric vessels at laparoscopic Nissen fundoplication, A prospective double-blind randomized trial with 5-year follow-up. Ann Surg 2002;235:165-70.
  16. Blomqvist A, Dalenbäck J, Hagedorn C, Lönroth H, Hyltander A, Lundell L. Impact of complete gastric fundus mobilization on outcome after laparoscopic total fundoplication. J Gastrointest Surg 2000;4:493-500.
  17. Watson DI, Pike GK, Baigrie RJ et al. Prospective double-blind randomized trial of laparoscopic Nissen fundoplication with division and without division of short gastric vessels. Ann Surg 1997;226:642-52.
  18. Herron DM, Swanstrom LL, Ramzi H, Hansen PD. Factors predictive of dysphagia after laparoscopic Nissen fundoplication. Surg Endosc 1999;13:1180-3.
  19. Papasavas PK, Keenan RJ, Yeaney WW, Caushaj PF, Gagné DJ, Landreneau RJ. Prediction of postoperative gas bloating after laparoscopic antireflux procedures based on 24-h pH acid reflux pattern. Surg Endosc 2003; 17:381-5.
  20. Collet D, Laurent C, Zerbib F, Monguillon M, Perissat J. Résultats fonctionnels du traitement laparoscopique du reflux gastro-oesophagien. Chirurgie 1998 ; 123 : 588-93.
  21. Slim K, Bousquet J, Kwiatkowski F, Lescure G, Pezet D, Chipponi J. Quality of life before and after laparoscopic fundoplication. Am J Surg 2000 ; 180 : 41-5.
  22. Franzen T, Bostrom J, Tibbing Grahn L, Johansson K. Prospective study of symptoms and gastro-oesophageal reflux 10 years after posterior partial fundoplication. Br J Surg 1999 ; 86 : 956-60.
  23. Farrel TM, Archer SB, Galloway KD, Branum GD, Smith CD, Hunter JG. Heartburn is more likely to recur after Toupet fundoplication than Nissen fundoplication. Am Surg 2000 ; 66 : 229-36.
  24. Ottignon Y, Pelissier E, Mantion G et al. Reflux gastro-oesophagien. Comparaison des résultats cliniques, pHmétriques et manométriques des procédés de Nissen et de Toupet. Gastroenterol Clin Biol 1994 ; 18 : 920-6.
  25. 25- Laws HL, Clements RH, Swillie CM. A randomized, prospective comparison of the Nissen fundoplication versus the Toupet fundoplication for the gastroesophageal reflux. Ann Surg 1997 ; 225 : 647-54.