Comparison of laparoscopic total and partial fundoplication for gastroesophageal reflux |
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Authors: | Marco G Patn MD Mario De Pinto MD Mario de Bellis MD Massimo Arcerito MD Fenry Tong MD Anne Wang MD Sean F Mulvibill MD Lawrence W Way MD |
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Institution: | (1) Department of Surgery, University of California, San Francisco, 533 Parnassus Ave. (U-122), 94143-0788 San Francisco, CA |
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Abstract: | Approximately 25% of patients with gastroesophageal reflux, severe enough to be considered for surgical treatment have dysfunction
of esophageal peristalsis in addition to dysfunction of the lower esophageal sphincter. A standard total (i.e., Nissen) fundoplication
in these patients may be followed by dysphagia, so many experts recommend a partial fundoplication as an alternative. The
goal of this study was to compare the clinical results and changes in esophageal function following laparoscopic total and
partial fundoplication. Ninety-three patients with gastroesophageal reflux disease had laparoscopic antireflux operations.
Total fundoplication was performed in 50 patients with normal esophageal peristalsis. Partial fundoplication was chosen for
43 patients with severe abnormalities of esophageal peristalsis. Partial fundoplication of patients has resolution of heartburn
(93%) and regurgitation (97%) after partial as compared to total fundoplication. Dysphagia developed in four patients (8%)
after total fundoplication (one patient required dilatation) and in no patients after partial fundoplication. Both operations
produced similar changes in lower esophageal sphincter function, but only partial fundoplication was associated with improvement
in esophageal dysfunction. Esophageal acid exposure became normal in 92% of patients after total and in 91% of patients after
partial fundoplication. Partial fundoplication improves lower esophageal sphincter pressure and esophageal body function and,
in patients with abnormal esophageal peristalsis, it corrects reflux without producing dysphagia. Partial and total fundoplication
are both indicated in patients with gastroesophageal reflux disease, and the choice of which procedure to use should be based
on each patient's specific esophageal motor function abnormalities.
Presented at the Thirty-Seventh Annual Meeting of The Society for Surgery of the Alimentary Tract, San Francisco Calif., May
19–22, 1996. |
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