4 research outputs found
Laparoscopic fundoplication for gastro-esophageal reflux disease: An 8 year experience
Background :Laparoscopic fundoplication (LF) has become the operation
of choice for patients who need surgery for gastro esophageal reflux
disease (GERD). Several studies have shown that the long-term results
with surgery for GERD are better than medical therapy. In this
retrospective study, we outline our experience with LF over an 8 year
period. We analyzed factors that would affect the results of surgery
and help in a better selection of patients for the operation.
Materials and Methods :From 1999 to 2007, 107 patients underwent a LF.
Eighty five patients had surgery for GERD and form the basis of this
article. The other 22 patients had paraesophageal hernias and were
excluded from the study. Pre-operative evaluation consisted of
endoscopy, a barium study, esophageal manometry and 24h pH monitoring.
Patients were followed up every 3rd month for the 1st year, twice in
the 2nd year and then annually. Follow up was by personal interview or
telephonic conversation. At the last follow up the results of surgery
were graded as good or poor as per a scoring system. Those with a poor
result were evaluated and re-operation advised when an anatomical
problem caused the poor result. Subjective, objective and technical
variables were analyzed which could affect the outcome of surgery.
Results :In 84 patients, the operation was completed by laparoscopic
access. One patient with bleeding was converted to open surgery. There
were 5 intra-operative complications; 3 pnemothoracis, 1 esophageal
perforation and 1 gastric fundus perforation. There was no mortality.
Two patients underwent re-operation, 1 for delayed gastric emptying and
1 for dysphagia. Seventy four patients have been followed up from 7
months to 8 years. Eleven have been lost to follow up. Fifty seven
patients (77%) have had a good result from surgery. Seventeen (23%) had
a poor result; of these there were 4 wrap failures, 1 delayed gastric
emptying and 1 excessive gas bloat as the cause. In 11 patients, there
was no apparent cause of a poor result. Individual variables which
predicted a good response to surgery ( P < 0.5); were a good
response to proton pump inhibitors (PPis), volume reflux and a pH score
of more than 14. Conclusion :LF gives good long-term relief of symptoms
in patients with GERD. Strict selection criteria are necessary to
optimize the results of surgery. Poor selection will result in a
patient who is no better, or often worse than before surgery