Laparoscopic antireflux surgery: indications, preoperative evaluation, techniques, and outcomes

Area of Science:

• Gastroenterology
• Minimally Invasive Surgery
• Surgical Oncology

Background:

• Mini-invasive surgery has increased the popularity of antireflux procedures.
• Gastroesophageal reflux disease (GERD) and hiatal hernias are common conditions requiring effective treatment.
• Failure of long-term medical therapy is a key indication for surgical intervention.

Purpose of the Study:

• To evaluate the indications, preoperative assessment, surgical techniques, and outcomes of mini-invasive antireflux surgery.
• To assess the efficacy and safety of laparoscopic fundoplication for GERD and hiatal hernias.

Main Methods:

• Laparoscopic surgery was performed on 25 patients with GERD and hiatal hernia between 1996 and 2000.
• Patients underwent either Nissen fundoplication (normal motility) or 270-degree posterior fundoplication (low motility).
• Preoperative evaluation included 24h-pH monitoring, endoscopy, and esophageal manometry.

Main Results:

• Zero mortality and conversion rates were achieved.
• Mean operative time was 130 minutes, with a mean postoperative hospital stay of 5 days.
• 96% of patients were symptom-free, with significant improvements in manometry and 24h-pH monitoring; 12% experienced transient dysphagia.

Conclusions:

• Laparoscopic antireflux surgery yields encouraging results with reduced morbidity and significant patient benefits.
• Careful patient selection and appropriate surgical technique are crucial for successful outcomes.
• Mini-invasive approaches represent a valuable option for managing complex GERD and hiatal hernia cases.