Fundoplicature laparoscopique pour reflux gastro-œsophagien. Étude multicentrique de 1 470 cas

Abstract

Study aim

The aim of this multicenter retrospective study was to evaluate the immediate and 2-year results of the laparoscopic fundoplication for gastroesophageal reflux disease (GERD).

Patients and methods

From 1992 to 1996, 1,470 laparoscopic fundoplications were performed for symptomatic GERD. Preoperative workup included upper Gl tract endoscopy in 1,437 patients (97.7%), 24-hour pHmetry in 799 patients (54.3%) and esophageal manometry in 934 patients (63.5%). Four procedures were performed: Nissen, Nissen-Rossetti, Toupet and Toupet with cardiopexy. The results were estimated at 1 month and 3 months. The patients were examined or called 2 years after surgery in order to evaluate the functional results with Visick classification.

Results

Mean length of hospital stay was 4.6 days (range 2–48 days). Morbidity and mortality rates were 3.2% (47 patients) and 0.07% (1 patient) respectively. Conversion rate into laparotomy was 6.5% (96 patients). After 3 months, 87 patients (5.9%) had severe dysphagia and 91.9% of the patients were satisfied. At 2 years, 78 patients (5.6%) had a clinical recurrence. Five patients (0.35%) had a persistent dysphagia, 90 patients (6.5%) had secondary side effects ; 38 patients had been reoperated ; 92.7% of the patients were satisfied. There was no significant difference between the results of the four procedures, 3 months and 2 years after surgery.

Conclusions

Laparoscopic fundoplication for treatment of GERD is a safe and effective procedure ; 92.7% of the patients were satisfied 2 years after surgery.