BACKGROUND: Complicated gastroesophageal reflux disease (GERD) requires long-term medical therapy, which in some instances is incompletely effective or poorly tolerated. Additionally, there is concern about the consequences of prolonged acid suppression therapy. Surgical correction of GERD has been a therapeutic option for decades. With the advent of video-assisted laparoscopic surgery, antireflux surgery has had a resurgence in popularity. PATIENTS AND METHODS: Between October 1992 and June 1995, 20 patients who underwent laparoscopic antireflux surgery were completely studied preoperatively and 3 months postoperatively with 24-hour pH monitoring and esophageal manometry. Follow-up averaged 18 months. The indication for surgery was medically refractory disease in 75%, intolerance to medication in 10%, and concern regarding the consequences of long-term medical therapy in 15%. Two thirds of these patients had complicated GERD. RESULTS: Operative time averaged 4 hours. There was no conversion to an open procedure. There was no mortality. Two patients had recurrent reflux, for a failure rate of 10%. Overall, postoperative reflux episodes and percent of time pH was less than 4 dropped significantly. Lower esophageal sphincter function showed a statistically significant increase in mean postoperative resting pressure and residual sphincter pressure during swallowing. There was no change in motility postoperatively. CONCLUSIONS: Laparoscopic antireflux surgery is a safe, effective, therapeutic alternative in the management of gastroesophageal reflux disease.
BACKGROUND: Complicated gastroesophageal reflux disease (GERD) requires long-term medical therapy, which in some instances is incompletely effective or poorly tolerated. Additionally, there is concern about the consequences of prolonged acid suppression therapy. Surgical correction of GERD has been a therapeutic option for decades. With the advent of video-assisted laparoscopic surgery, antireflux surgery has had a resurgence in popularity. PATIENTS AND METHODS: Between October 1992 and June 1995, 20 patients who underwent laparoscopic antireflux surgery were completely studied preoperatively and 3 months postoperatively with 24-hour pH monitoring and esophageal manometry. Follow-up averaged 18 months. The indication for surgery was medically refractory disease in 75%, intolerance to medication in 10%, and concern regarding the consequences of long-term medical therapy in 15%. Two thirds of these patients had complicated GERD. RESULTS: Operative time averaged 4 hours. There was no conversion to an open procedure. There was no mortality. Two patients had recurrent reflux, for a failure rate of 10%. Overall, postoperative reflux episodes and percent of time pH was less than 4 dropped significantly. Lower esophageal sphincter function showed a statistically significant increase in mean postoperative resting pressure and residual sphincter pressure during swallowing. There was no change in motility postoperatively. CONCLUSIONS: Laparoscopic antireflux surgery is a safe, effective, therapeutic alternative in the management of gastroesophageal reflux disease.