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[Antireflux surgery, comperative study of three laparascopic techniques].
Rev Gastroenterol Mex 2005 Oct-Dec; 70(4):402-10RG

Abstract

Laparoscopic fundoplication for the surgical treatment of gastroesophageal reflux disease is widely accepted all over the world.

OBJECTIVE

To compare clinical results of patients operated with the Nissen, Nissen-Rossetti and Toupet techniques, in Centro Medico ABC, for the treatment of pathologic gastroesophageal reflux, and to determine if there is a difference when dividing the short gastric vessels with complete mobilization of the gastric fundus.

MATERIAL AND METHOD

We carried out a retrospective, longitudinal, comparative and observational study of 241 laparoscopic fundoplications performed in Centro Medico ABC, between January 2000 and May 2001. The following variables were analyzed: age, sex, smoking, habits, drinking habits, time of evolution of gastroesophageal reflux, typical and atypical clinical manifestations, medical treatment received, preoperative dysphagia, hiatal hernia, degree of esophagitis, Barrett's esophagus, esophageal motility disorders, preoperative and postoperative pressure of the inferior esophageal sphincter, 24-hour pH monitoring, type of fundoplication, division of short gastric vessels, complete mobilization of the gastric fundus, closure of the pillars, diameter of probang, fundoplication fixed to the right pillar, suture applied, transoperative endoscopy, days of hospitalization, time before applying orally, morbidity and mortality. For the clinical follow-up, patients were contacted via telephone, assessing the following variables: dysphagia for liquids, dysphagia for solids, heartburn, postprandial fullness, gastric bubble, ability to belch, flatulence, diarrhea, medical treatment post-fundoplication, esophageal dilatation, reoperation, satisfaction with procedure divided into 5 levels: excellent, satisfied, moderately satisfied, poorly satisfied, unsatisfied and, for each group, the modified Visick scale was included. These variables were analyzed and compared between Nissen, Nissen-Rossetti and Toupet fundoplication, attempting to identify a significant statistical difference. Qualitative analysis; Chi-square at p < 0.05.

RESULTS

241 patients underwent laparoscopic fundoplication surgery in Centro Medico ABC between January 2000 and May 2001. 27.4% (n = 66) corresponded to Nissen fundoplication, 31.5% (n = 76) to Nissen-Rossetti and 41.1% (n = 99) to Toupet. Males predominated at 65.6% (n = 158). Average age was 42 years ranging from 18 to 76 years old. We were able to contact and interview 231 patients via telephone, which corresponded to 95.8%. The average follow-up time was 12 months, ranging from 6 to 18 months in which the control of gastroesophageal reflux was higher for the Nissen group at 98.5%, Nissen-Rossetti 93% and Toupet 73% with statistical significance p < 0.001. In the Toupet group 27% (n = 26) had recurrent heartburn and 11% (n = 8) had persistent dysphagia in the Nissen-Rossetti group p < 0.001. Six patients underwent reoperation, five (7%) of the Nissen-Rossetti group due to severe dysphagia and one (1%) of the Toupet group due to the dismantling of the fundoplication and recurrence of symptoms p < 0.001. The clinical condition during follow-up was superior for the Nissen group (Visick I-II in 98.5% p < 0.001). Morbidity was 2.4%, with no operative mortality.

CONCLUSION

Our results are comparable to the ones published in the world literature. In our hands, a Nissen fundoplication with complete mobilization of the fundus yielded the best results, a Nissen-Rossetti operation had more disphagia and more reoperations and a partial fundoplication of Toupet, had a higher incidence of recurrent heartburn.

Authors+Show Affiliations

Departamento de Cirugía General, Centro Médico ABC, México, D.F. drgomez@optical.com.mxNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
English Abstract
Journal Article

Language

spa

PubMed ID

17058979

Citation

Gómez Cárdenas, Xavier, et al. "[Antireflux Surgery, Comperative Study of Three Laparascopic Techniques]." Revista De Gastroenterologia De Mexico, vol. 70, no. 4, 2005, pp. 402-10.
Gómez Cárdenas X, Flores Armenta JH, Elizalde Di Martino A, et al. [Antireflux surgery, comperative study of three laparascopic techniques]. Rev Gastroenterol Mex. 2005;70(4):402-10.
Gómez Cárdenas, X., Flores Armenta, J. H., Elizalde Di Martino, A., Guarneros Zárate, J. E., Cervera Servín, A., Ochoa Gómez, R., & Quijano Orvañanos, F. (2005). [Antireflux surgery, comperative study of three laparascopic techniques]. Revista De Gastroenterologia De Mexico, 70(4), pp. 402-10.
Gómez Cárdenas X, et al. [Antireflux Surgery, Comperative Study of Three Laparascopic Techniques]. Rev Gastroenterol Mex. 2005;70(4):402-10. PubMed PMID: 17058979.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Antireflux surgery, comperative study of three laparascopic techniques]. AU - Gómez Cárdenas,Xavier, AU - Flores Armenta,Jesús Humberto, AU - Elizalde Di Martino,Alexandro, AU - Guarneros Zárate,Joaquín Eugenio, AU - Cervera Servín,Andrés, AU - Ochoa Gómez,Ramón, AU - Quijano Orvañanos,Fernando, PY - 2006/10/25/pubmed PY - 2006/12/9/medline PY - 2006/10/25/entrez SP - 402 EP - 10 JF - Revista de gastroenterologia de Mexico JO - Rev Gastroenterol Mex VL - 70 IS - 4 N2 - UNLABELLED: Laparoscopic fundoplication for the surgical treatment of gastroesophageal reflux disease is widely accepted all over the world. OBJECTIVE: To compare clinical results of patients operated with the Nissen, Nissen-Rossetti and Toupet techniques, in Centro Medico ABC, for the treatment of pathologic gastroesophageal reflux, and to determine if there is a difference when dividing the short gastric vessels with complete mobilization of the gastric fundus. MATERIAL AND METHOD: We carried out a retrospective, longitudinal, comparative and observational study of 241 laparoscopic fundoplications performed in Centro Medico ABC, between January 2000 and May 2001. The following variables were analyzed: age, sex, smoking, habits, drinking habits, time of evolution of gastroesophageal reflux, typical and atypical clinical manifestations, medical treatment received, preoperative dysphagia, hiatal hernia, degree of esophagitis, Barrett's esophagus, esophageal motility disorders, preoperative and postoperative pressure of the inferior esophageal sphincter, 24-hour pH monitoring, type of fundoplication, division of short gastric vessels, complete mobilization of the gastric fundus, closure of the pillars, diameter of probang, fundoplication fixed to the right pillar, suture applied, transoperative endoscopy, days of hospitalization, time before applying orally, morbidity and mortality. For the clinical follow-up, patients were contacted via telephone, assessing the following variables: dysphagia for liquids, dysphagia for solids, heartburn, postprandial fullness, gastric bubble, ability to belch, flatulence, diarrhea, medical treatment post-fundoplication, esophageal dilatation, reoperation, satisfaction with procedure divided into 5 levels: excellent, satisfied, moderately satisfied, poorly satisfied, unsatisfied and, for each group, the modified Visick scale was included. These variables were analyzed and compared between Nissen, Nissen-Rossetti and Toupet fundoplication, attempting to identify a significant statistical difference. Qualitative analysis; Chi-square at p < 0.05. RESULTS: 241 patients underwent laparoscopic fundoplication surgery in Centro Medico ABC between January 2000 and May 2001. 27.4% (n = 66) corresponded to Nissen fundoplication, 31.5% (n = 76) to Nissen-Rossetti and 41.1% (n = 99) to Toupet. Males predominated at 65.6% (n = 158). Average age was 42 years ranging from 18 to 76 years old. We were able to contact and interview 231 patients via telephone, which corresponded to 95.8%. The average follow-up time was 12 months, ranging from 6 to 18 months in which the control of gastroesophageal reflux was higher for the Nissen group at 98.5%, Nissen-Rossetti 93% and Toupet 73% with statistical significance p < 0.001. In the Toupet group 27% (n = 26) had recurrent heartburn and 11% (n = 8) had persistent dysphagia in the Nissen-Rossetti group p < 0.001. Six patients underwent reoperation, five (7%) of the Nissen-Rossetti group due to severe dysphagia and one (1%) of the Toupet group due to the dismantling of the fundoplication and recurrence of symptoms p < 0.001. The clinical condition during follow-up was superior for the Nissen group (Visick I-II in 98.5% p < 0.001). Morbidity was 2.4%, with no operative mortality. CONCLUSION: Our results are comparable to the ones published in the world literature. In our hands, a Nissen fundoplication with complete mobilization of the fundus yielded the best results, a Nissen-Rossetti operation had more disphagia and more reoperations and a partial fundoplication of Toupet, had a higher incidence of recurrent heartburn. SN - 0375-0906 UR - https://www.unboundmedicine.com/medline/citation/17058979/[Antireflux_surgery_comperative_study_of_three_laparascopic_techniques]_ L2 - https://medlineplus.gov/gerd.html DB - PRIME DP - Unbound Medicine ER -