Laparoscopic treatment of gastro-esophageal reflux disease: indications and results

This paper deals with the indications, techniques and results of laparoscopic total or partial posterior fundoplications (Nissen and Toupet procedures, respectively) performed in 41 patients with gastroesophageal reflux disease (GERD) failing to respond to medical treatment. Stationary manometry and 24-hour esophageal pH monitoring established the indications for surgery. Laparoscopy was attempted in all patients, even when giant mixed or para-esophageal herniations were present. The rate of conversion to laparotomy amounted to 12.2%. There were no intraoperative complications. Major complications were observed in 3 patients (8%) and included 2 cases of slipped Nissen and 1 of pneumonia. Four patients had persistent postoperative dysphagia; two of them were re-operated and two were treated with pneumatic dilatation. Reflux only recurred in 1 patient. Functional follow-p demonstrated an overall increase in LES resting pressure and length, with no abnormal gastro-esophageal reflux episodes, findings which tended to persist in the long term.