Laparoscopic hiatal herniorrhaphy with posterior fundoplication for gastroesophageal reflux

Complications and side effects following laparoscopic antireflux procedures are common. This article describes an alternative laparoscopic technique to prevent gastroesophageal reflux. This method consists of posterior approximation of the diaphragmatic crura followed by a posterior fundoplication of approximately 270 degrees wrap. In avoiding the 360 degree wrap and obtaining length from the longitudinal axis of the stomach, it is not necessary to take down the gastrosplenic vessels. The principle of the procedure is to accentuate the cardioesophageal angle of His. No sutures are placed in the esophagus. While this article primarily concerns technique, it also constitutes a brief report on the first 50 patients who have been followed up for 1 year or more. All patients but one are free of reflux symptoms and have discontinued taking all medication. There has been no dysphagia to liquids, and solid food dysphagia has not lasted >1 month. Bloating from gas is minimal, as most patients are able to burp early in their recovery. An outcome paper describing preoperative and postoperative objective testing and evaluation is in process.