A Modified Approach to Laparoscopic Antireflux Surgery May Decrease Postoperative Dysphagia and Gas Bloat Syndrome

作者：Hussain Abdulzahra^*; Mahmood Hind; Nicholls Jackie; El Hasani Shamsi

来源：Surgical Laparoscopy Endoscopy & Percutaneous Techniques, 2010, 20(3): E84-E88.

DOI：10.1097/SLE.0b013e3181da480b

• laparoscopic antireflux surgery
• antireflux surgery
• laparoscopic Nissen fundoplication
• gastroesophageal junction
• spiral wrap
• gastroesophageal reflux disease

Background: Laparoscopic antireflux surgery has passed the test of time to prove its efficacy and advantage over the traditional approach. Several modifications of the original Nissen fundoplication have been introduced and practiced by surgeons with variable outcomes.
Methods: This modified technique of laparoscopic fundoplication, which we use, is basically a spiral wrap. It is constructed by using several specifically located Ethibond stitches to keep the gastroesophageal junction and a length of the esophagus inside the abdomen without esophageal stitching. Postoperative outcome including patient satisfaction was assessed clinically during follow-up visits. Patients with recurrent symptoms and complications were assessed by appropriate tests. All patients were seen at 6 weeks, 6 months, 12 months, and annually after the operation.
Results: Fifty-seven patients underwent laparoscopic antireflux surgery using the spiral wrap technique. Four patients reported occasional heartburn and only 1 patient developed regurgitation after 1 year from the operation. Nine patients developed early dysphagia and 2 patients had gas bloat syndrome at 6 weeks postoperative assessment. No dysphagia or gas bloat syndrome was confirmed after a year and no revisional surgery was reported.
Conclusions: Modification of the classic fundoplication to spiral wrap is associated with acceptable morbidity and low incidence of postoperative dysphagia and gas bloat syndrome.

• 出版日期2010-6