Causas de conversión en la cirugía laparoscópica de la enfermedad por reflujo gastroesofágico: análisis de nuestra experiencia

Background: since its introduction in 1991 laparoscopic an tireflux surgery has gained great success and popularity among surgeons,andnowitisthegoldstandardforthetreatmentofgas troesophagealrefluxdisease(GERD). Aim: to identify and evaluate the causes of conversion in the laparoscopicsurgeryofGERDandhiatushernia. Material and methods: sinceJanuary1993toAugust2007 606 laparoscopic antireflux procedures were performed in our hospital. There were 296 women and 310 men with a median age of 53.5 years. The main indication for surgery was evidence of intractable or recurrent GERD symptoms after adequate med ical treatment with associated hiatal hernia. The preoperative workupincludedmanometry,pH-metry,oralendoscopy,andbar ium swallow. The surgical technique was mainly the Nissen-Ros settiprocedure. Results: mean postoperative hospital stay was 2.7 days. The operation had to be converted to an open procedure in 43 cases (7%). Conversions were more frequent in the first decade of the learning curve (26 vs. 17, p < 0.016), and fewer among the groupofexpertsinadvancedlaparoscopicsurgery(15 vs.28, p < 0.017). In 17 cases conversions were due to an intraopera tive complication whereas in 26 cases a conversion was done be cause of technical difficulties. Esophageal perforation and pneu mothorax rates were 0.8 and 1%, respectively, and mortality and morbidityrateswere0.1and12%. Conclusion: the rate of conversion is acceptable and significantlydecreaseswithsurgeonexperience.