[Laparoscopic treatment of gastroesophageal reflux]

Gastroesophageal reflux disease (GERD) is a frequent illness, sometimes causing disabling symptoms and/or permanent oesophageal lesions. Etiology is multifactorial and not completely defined. Therapy is medical at first step, surgical indication is reserved to those patients with less compliance for medical therapy, unsuccessful medical therapy or reflux related complications. Different surgical techniques have been suggested for treatment of GERD, like Nissen, Rossetti or Toupet fundoplication. During the last decade laparoscopy has been proposed as a less invasive approach when surgery is indicated. From 1995 to the first months of 1999, 42 pts (28 females, 14 males, mean age 53.7 years), were operated on. Diagnosis and surgical indication were confirmed preoperatively by barium X-rays, endoscopy and 24 hrs-Ph-manometry. Hiatal hernia was demonstrated in 37 cases (88%), I or II grade esophagitis in 16 and III grade in 2; 1 patient had Barrett oesophagus. 37 pts were operated on by laparoscopic Nissen fundoplication, 5 patients had a Toupet operation. Mortality and conversion rate were 0. Complications occurred in 3 patients: 1 intraoperative pneumothorax, 1 acute cardiac ischemia in a patient with known hypertension, 1 permanent dysphagia successfully treated by endoscopic dilatation. Mean postoperative hospital stay was 6.1 days. Mean follow up was 9 months (3-48) in 100% of cases. Despite the fact that few patients were operated on by using this new less invasive approach, results are encouraging with no mortality, less morbidity and great advantages for patients.