[Analysis of surgery of gastroesophageal reflux by laparotomy and laparoscopy approach]

The development of the laparoscopic surgery has allowed its use in the treatment of gastroesophageal reflux.

We have reviewed the results and follow-up of 30 patients treated with open procedure (group A) and 30 patients with laparoscopic surgery (group B). The most frequent indication for surgery was failure of medical therapy and the Nissen fundoplication was the method most commonly used.

The average surgical time was shorter in group A (66 minutes) than in group B (140 minutes). Intraoperative complications were: in group A, 2 patients with splenic injury; in group B, 3 patients required conversion to the open procedure (pneumothorax, gastric perforation, technical problems) and 1 patient with pneumothorax which didn't require conversion. Postoperative morbidity and mortality occurred in 20% (26% group A, 13% group B); the most common complications were: respiratory (4 patients), gas bloat syndrome (2 patients) and esophageal perforation (1 patient). At follow-up we observed complete heartburn relief in 95%, 4 patients in group A had mild dysphagia, 3 patients with recurrent hiatal hernia (2 in group A and 1 in group B) and 2 patients required reintervention in group A (intestinal occlusion caused by adherence and laparotomic hernia). Mortality occurred in a patient with esophageal perforation in group B.

Treatment for gastroesophageal reflux is feasible with similar effectiveness with open and laparoscopic procedures. The results are advantageous with the laparoscopic procedure relative to postoperative morbidity and follow-up.