[Laparoscopic treatment of gastroesophageal reflux: report of 51 cases].

BACKGROUND: The fundoplication to treat gastroesophageal reflux disease have proven themselves in open surgery and are being validated by laparoscopy. BUT: The purpose of this retrospective study was to evaluate the results in the short and medium term treatment of gastroesophageal reflux by laparoscopy in a series of 51 patients and compare our results with those of literature. METHODS: We report the results of a retrospective study of 51 consecutive patients operated by laparoscopy for gastro-esophageal reflux during the period January 2000 to December 2004. The indication for surgery was the drug resistance (persistence of symptoms of reflux on treatment), drug addiction, persistent esophagitis after a well conducted medical treatment and endobrachy-esophagus. All our patients had a total or partial fundoplication. Our outcome measures were mortality, morbidity, specifically, the conversion rate and functional outcome in the short and medium term. RESULTS: These 24 men and 27 women of average age 38 years (range: 17-71 ans). All patients were approached first by laparoscopy. All our patients had a fundoplication: 44 total, including 10 with section of short vessels (Nissen) and 34 without section of short vessels (Nissen-Rossetti). The other 7 patients had a partial posterior fundoplication of 180 degrees. We used the conversion in four patients (7.8%). Mortality was nil. The specific complications were observed in 2 patients (4%), a case of gastroparesis positive trends in gastric aspiration. A case of aphagie requiring reoperation for postoperative J2 to convert a valve type Nissen-Rossetti valve type Toupet. The non-specific complications were dominated by pneumonia in 4 patients (7.8%). In the medium term, gas bloat syndrome was present in 7.8% of cases. Dysphagia, present in (77%) cases, was transient in 40 patients (62%) and persistent in 15 patients including 2 requiring dilation sessions. One patient experienced a recurrence of reflux confirmed by pH monitoring. CONCLUSION: the laparoscopic approach is being validated in the surgical treatment of gastroesophageal reflux. In our series of 51 patients, the results were satisfactory and comparable to those of the literature.