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[Antireflux surgery, comperative study of three laparascopic techniques].
Xavier Gómez Cárdenas1, Jesús Humberto Flores Armenta, Alexandro Elizalde Di Martino
1Departamento de Cirugía General, Centro Médico ABC, México, D.F. drgomez@optical.com.mx
Revista De Gastroenterologia De Mexico
|October 25, 2006
Summary
Nissen fundoplication with complete gastric fundus mobilization offers superior gastroesophageal reflux disease treatment outcomes. This surgical approach resulted in better symptom control and fewer reoperations compared to Nissen-Rossetti and Toupet techniques.
Area of Science:
- Gastroenterology and Surgical Innovation
- Minimally Invasive Surgery Techniques
- Gastroesophageal Reflux Disease (GERD) Management
Background:
- Laparoscopic fundoplication is a globally accepted surgical treatment for gastroesophageal reflux disease (GERD).
- Variations in surgical techniques, including Nissen, Nissen-Rossetti, and Toupet fundoplications, exist with differing clinical outcomes.
- The impact of mobilizing the gastric fundus and dividing short gastric vessels on surgical success requires further comparative analysis.
Purpose of the Study:
- To compare the clinical effectiveness of Nissen, Nissen-Rossetti, and Toupet laparoscopic fundoplication techniques.
- To evaluate the influence of complete gastric fundus mobilization and short gastric vessel division on surgical outcomes for GERD.
- To identify significant differences in patient satisfaction and symptom recurrence between these surgical approaches.
Main Methods:
- A retrospective, longitudinal, comparative study of 241 laparoscopic fundoplications performed between January 2000 and May 2001.
- Analysis of patient demographics, clinical manifestations, preoperative conditions, and surgical variables including fundoplication type and gastric mobilization.
- Postoperative follow-up via telephone interviews assessing dysphagia, heartburn, reflux control, and patient satisfaction using the modified Visick scale.
Main Results:
- The Nissen fundoplication group demonstrated superior control of gastroesophageal reflux (98.5%) compared to Nissen-Rossetti (93%) and Toupet (73%) (p < 0.001).
- The Toupet group experienced higher rates of recurrent heartburn (27%), while the Nissen-Rossetti group had more persistent dysphagia (11%) (p < 0.001).
- Nissen fundoplication resulted in the best clinical outcomes (Visick I-II in 98.5%), with lower reoperation rates and overall morbidity (2.4%) and no mortality.
Conclusions:
- Laparoscopic Nissen fundoplication with complete gastric fundus mobilization yields the best clinical results in our experience.
- Nissen-Rossetti operations are associated with increased dysphagia and reoperations.
- The Toupet partial fundoplication shows a higher incidence of recurrent heartburn, suggesting technique-specific limitations.
