Abstract
Background
Several different ways of fashioning a total fundoplication lead to different outcomes. This article addresses the technical details of the antireflux technique we adopted without modifications for all patients with GERD beginning in 1972. In particular it aims to discuss the relation between the mechanism of function of the wrap and the physiology of the esophagus.
Methods
The study population consisted of 380 patients affected by GERD with a 1-year minimum of follow-up who underwent laparoscopic Nissen-Rossetti fundoplication by a single surgeon.
Results
No conversion to open surgery and no mortality occurred. Major complications occurred in 4 patients (1.1%). Follow-up (median 83 months; range: 1–13 years) was achieved in 96% of the patients. Ninety-two percent of the patients were satisfied with the results of the procedure and would undergo the same operation again. Postoperative dysphagia occurred in 3.5% of the patients, and recurrent heartburn was observed in 3.8%.
Conclusions
Laparoscopic Nissen-Rossetti fundoplication with the routine use of intraoperative manometry and endoscopy achieved good outcomes and long-term patient satisfaction with few complications and side-effects. Appropriate preoperative investigation and a correct surgical technique are important in securing these results.
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REFERENCES
Catarci M, Gentileschi P, Papi C, et al. Evidence-based appraisal of antireflux fundoplication. Ann Surg 2004;239:325–337
Del Genio A, Pignatelli C, Chiariello L, et al. La elettromanometria nello studio della funzione motoria dell’esofago. Rass Med Sperim 1968;15:58–81
Rossetti G, Brusciano L, Amato G, et al. A total fundoplication is not an obstacle to esophageal emptying after Heller myotomy for achalasia: results of a long-term follow up. Ann Surg 2005;241:614–621
Del Genio A, Rossetti G, Maffettone V, et al. Laparoscopic approach in the treatment of epiphrenic diverticula: long-term results. Surg Endosc 2004;18:741–745
Amato G, Napolitano V, Di Martino N, et al. L’impiego dell’esofagoscopio a fibre ottiche nel corso di interventi chirurgici dell’esofago. Giorn Ital Chir 1981;37:105–107
Del Genio A, Izzo G, Di Martino N, et al. Intraoperative esophageal manometry: our experience. Dis Esophagus 1997;10:253–261
Donahue PE, Samelson S, Nyhus LM, et al. The floppy Nissen fundoplication. Effective long-term control of pathologic reflux. Arch Surg 1985;120:663–668
DeMeester TR, Bonavina L, Albertucci M. Nissen fundoplication for gastroesophageal reflux disease. Evaluation of primary repair in 100 consecutive patients. Ann Surg 1986;204:9–20
Patterson EJ, Herron DM, Hansen PD, et al. Effect of an esophageal bougie on the incidence of dysphagia following Nissen fundoplication. Arch Surg 2000;135:1055–1062
Del Genio G, Collard JM. Acute complications of antireflux surgery. In Ferguson MK and Fennerty MB, editors, Managing Failed Anti-Reflux Therapy, London, Springer, 2006
Del Genio A, Izzo G, Maffettone V, et al. What are the results of antireflux valves? In Giuli R, Tytgat GNJ, De Meester TR, Galmiche JP, editors, The Esophageal Mucosa, Amsterdam, Elsevier, 1994:573–586
Pandolfino JE, Curry J, Shi G, et al. Restoration of normal distensive characteristics of the esophagogastric junction after fundoplication. Ann Surg 2005;242:43–48
Del Genio A, Izzo G, Maffettone V, et al. What is the degree of obstruction to swallowing created by the Nissen valve? In Giuli R., Tytgat GNJ., DeMeester TR., Galmiche JP, editors, The Esophageal Mucosa, Amsterdam, Elsevier, 1994:623–629
De Ponti F, Azpiroz F, Malagelada JR. Relaxatory responses of canine proximal stomach to esophageal and duodenal distension. Importance of vagal pathways. Dig Dis Sci 1989;34:873–881
Izzo G, Landolfi V, Amato G, et al. Pharyngoesophageal transmural potential difference in normal subjects and in patients with peptic esophagitis. Ital J Surg Sci 1986;16:255–259
Di Martino N, Bortolotti M, Izzo G, et al. 24-hour esophageal ambulatory manometry in patients with achalasia of the esophagus. Dis Esophagus 1997;10:121–127
Rossetti M, Hell K. Fundoplication for the treatment of gastroesophageal reflux in hiatal hernia. World J Surg 1977;1:439–443
Anvari M, Allen C. Laparoscopic Nissen fundoplication: two-year comprehensive follow-up of a technique of minimal paraesophageal dissection. Ann Surg 1998;227:25–32
Watson DI, Pike GK, Baigrie RJ, et al. Prospective double-blind randomized trial of laparoscopic Nissen fundoplication with division and without division of short gastric vessels. Ann Surg 1997;226:642–652
O’Boyle CJ, Watson DI, Jamieson GG, et al. Division of short gastric vessels at laparoscopic Nissen fundoplication: a prospective double-blind randomized trial with 5-year follow-up. Ann Surg 2002;235:165–170
Chrysos E, Tzortzinis A, Tsiaoussis J, et al. Prospective randomized trial comparing Nissen to Nissen-Rossetti technique for laparoscopic fundoplication. Am J Surg 2001;182:215–221
Pessaux P, Arnaud JP, Delattre JF, et al. Laparoscopic antireflux surgery: five-year results and beyond in 1340 patients. Arch Surg 2005;140:946–951
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del Genio, G., Rossetti, G., Brusciano, L. et al. Laparoscopic Nissen-Rossetti Fundoplication with Routine Use of Intraoperative Endoscopy and Manometry: Technical Aspects of a Standardized Technique. World J Surg 31, 1100–1107 (2007). https://doi.org/10.1007/s00268-006-0495-5
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DOI: https://doi.org/10.1007/s00268-006-0495-5