J K Champion1. 1. Department of Surgery, Emory-Dunwoody Medical Center, 4575 North Shallowford Road, Atlanta, GA 30038, USA. jkchamp@juno.com
Abstract
BACKGROUND: To determine the indications for a minimally invasive thoracic technique in gastroesophageal reflux disease (GERD), we conducted a retrospective review of outcomes with our first 21 thoracoscopic Belsey fundoplications. METHODS: A thoracoscopic Belsey fundoplication was completed in 21 patients (12 males, 9 female; ages, 38-83 years). Preoperative evaluation revealed 13 primary motility disorders, 9 strictures, and 3 epiphrenic diverticuli. Six patients had previous gastric surgery. Sixteen patients underwent 20 ancillary procedures (esophagomyotomy, 14; excision of diverticulum, 2; lung volume reduction, 2; prosthetic diaphragmatic repair, 1; and Thal-Woodward esophagoplasty, 1). RESULTS: Mean follow-up was 75.6 months (range, 67-85 months). There was one operative death (4.8%). Early morbidity included two esophageal leaks (9.8%). Late morbidity included three patients (15.7%) with persistent dysphagia and five patients (26%) with recurrent GERD. CONCLUSION: Thoracoscopic Belsey fundoplication was associated with a high morbidity and recurrence rate in our long-term experience.
BACKGROUND: To determine the indications for a minimally invasive thoracic technique in gastroesophageal reflux disease (GERD), we conducted a retrospective review of outcomes with our first 21 thoracoscopic Belsey fundoplications. METHODS: A thoracoscopic Belsey fundoplication was completed in 21 patients (12 males, 9 female; ages, 38-83 years). Preoperative evaluation revealed 13 primary motility disorders, 9 strictures, and 3 epiphrenic diverticuli. Six patients had previous gastric surgery. Sixteen patients underwent 20 ancillary procedures (esophagomyotomy, 14; excision of diverticulum, 2; lung volume reduction, 2; prosthetic diaphragmatic repair, 1; and Thal-Woodward esophagoplasty, 1). RESULTS: Mean follow-up was 75.6 months (range, 67-85 months). There was one operative death (4.8%). Early morbidity included two esophageal leaks (9.8%). Late morbidity included three patients (15.7%) with persistent dysphagia and five patients (26%) with recurrent GERD. CONCLUSION: Thoracoscopic Belsey fundoplication was associated with a high morbidity and recurrence rate in our long-term experience.
Authors: Dimitrios Stefanidis; William W Hope; Geoffrey P Kohn; Patrick R Reardon; William S Richardson; Robert D Fanelli Journal: Surg Endosc Date: 2010-08-20 Impact factor: 4.584