Impact of complete gastric fundus mobilization on outcome after laparoscopic total fundoplication

With the objective of further optimizing the outcome of antireflux surgery, we have studied the importance of dividing the short gastric vessels when performing a laparoscopic total fundoplication. Ninety-nine consecutive patients with chronic gastroesophageal reflux disease (GERD) were enrolled in the trial. Forty-seven patients (25 men, age 52 +/- 1.6 years [mean +/- standard error]) were randomized to undergo a laparoscopic Nissen-Rossetti total fundic wrap with intact short gastric vessels, whereas 52 patients (29 men, 48 +/- 1.4 years) had complete division of these vessels. Quality of life was assessed by means of the psychological general well-being and gastrointestinal symptom rating scale indices. The 6- and 12-month follow-up data are reported. Two patients were converted to open surgery. Mobilization of the fundus significantly prolonged the operative time (120 vs. 104 minutes, P = 0.05); otherwise the complication rates were similar in the two groups. Both procedures were equally effective in controlling gastroesophageal reflux at 6 and 12 months' postoperatively. Division of the short gastric vessels had no significant impact on the point prevalence of postfundoplication complaints at the given follow-up time points. Quality of life was significantly improved by both operative procedures and remained "normal" throughout the follow-up period. Dividing all short gastric vessels had no impact on the functional outcome during the first year of recovery after a total laparoscopic fundoplication.