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Effect of laparoscopic partial fundoplication on reflux mechanisms
Maud A Lindeboom1, Jan Ringers, Jan-Wilten A Straathof
1Department of Surgery and, Leiden University Medical Center, Leiden, The Netherlands.
The American Journal of Gastroenterology
|January 16, 2003
Summary
Laparoscopic partial fundoplication effectively reduces transient lower esophageal sphincter relaxations (TLESRs) and reflux episodes. This surgical approach improves lower esophageal sphincter pressure, leading to better management of gastroesophageal reflux disease.
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
- Gastroesophageal Reflux Disease Management
Background:
- Transient lower esophageal sphincter relaxations (TLESRs) are the primary cause of gastroesophageal reflux.
- Therapy-resistant reflux disease often necessitates surgical intervention.
- Laparoscopic partial fundoplication is employed to mitigate dysphagia post-surgery.
Purpose of the Study:
- To investigate the impact of laparoscopic partial fundoplication on TLESRs.
- To evaluate the effects on other gastroesophageal reflux mechanisms.
- To understand the management of refractory reflux disease.
Main Methods:
- A prospective study involving 28 patients undergoing laparoscopic partial fundoplication (180-200 degrees).
- Simultaneous recording of esophageal pH and lower esophageal sphincter (LES) pressure via sleeve manometry.
- Pre-operative and 6-month post-operative evaluations were conducted.
Main Results:
- Basal LES pressure significantly increased post-surgery (14.3 to 17.8 mm Hg).
- TLESR frequency significantly decreased in both fasting and postprandial states.
- The number of reflux episodes and TLESR-associated reflux significantly reduced.
Conclusions:
- Laparoscopic partial fundoplication enhances LES pressure and reduces TLESR frequency.
- The procedure leads to significant reduction in esophageal acid exposure.
- Postprandial LES characteristics are preserved following surgery.