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Antireflux surgery in the laparoscopic era
1University Department of Surgery, Royal Adelaide Hospital, South Australia, Australia.
The British Journal of Surgery
|September 30, 1998
Summary
Laparoscopic fundoplication reduces early morbidity for gastro-oesophageal reflux disease surgery. A short, loose Nissen fundoplication is currently appropriate, but long-term outcomes require further study.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Medical Technology
Background:
- Laparoscopic fundoplication has renewed interest in surgical treatment for gastro-oesophageal reflux disease (GERD).
- Technical standardization in laparoscopic antireflux surgery remains a challenge, with ongoing debate regarding optimal techniques.
- Critical reassessment of laparoscopic surgery outcomes is necessary to define its current role in GERD management.
Purpose of the Study:
- To critically evaluate the outcomes of laparoscopic antireflux surgery.
- To determine the current status of laparoscopic surgical techniques for GERD.
Main Methods:
- Review of published outcome studies on laparoscopic antireflux surgery.
- Inclusion of selected studies from the open antireflux surgery era for comparative assessment.
Main Results:
- Laparoscopic antireflux surgery demonstrates reduced early overall morbidity compared to open procedures.
- Certain complications like paraoesophageal hiatus herniation and oesophageal perforation may be more frequent, necessitating specific surgical strategies.
- Evidence does not support routine posterior partial fundoplication or routine division of short gastric vessels in Nissen fundoplication.
Conclusions:
- A short, loose Nissen fundoplication performed laparoscopically is a suitable surgical approach for GERD.
- Long-term outcomes of various laparoscopic antireflux surgery techniques are still pending and require further investigation before definitive conclusions can be drawn.