Abstracts
2001 Digestive Disease Week

# 2440 Laparoscopic Antireflux Surgery with Routine Hiatoplasty in the Treatment of Gastroesophageal Reflux Disease
Frank A. Granderath, Ursula M. Schweiger, Thomas Kamolz, Tanja Bammer, Martin Pasiut, Christoph F. Haas, Rudolph Pointner, Zell am See, Austria

During the last years laparoscopic antireflux surgery (LARS) has become the standard procedure in the treatment of severe gastroesophageal reflux disease (GERD). Both, LARS and open surgery cause failures which lead in 3 to 6% of cases to redo-surgery. One of the most occuring complications after LARS is the intrathoracic migration of the wrap. Aim of the present study was to to evaluate prospectively the outcome of a series of 115 patients who underwent "floppy" Nissen or Toupet fundoplication with routine hiatoplasty in comparison to 360 patients with simple non-absorbable polypropylene sutures. Since 1998, every patient who underwent LARS, a 1x3 cm polyvinyl mesh was placed on the hiatus behind the esophagus to guarantuee an effective closure of the hiatus. In the initial series of 360 patients a postoperative herniation of the wrap occured in 16 cases ( 4.4%). In comparison to these results, in 115 patients who received a routine hiatoplasty there was only one patient (0.8%) who had a herniation of the wrap into the chest by an inadaequate placement of the mesh. After laparoscopic redo-surgery the patient showed normal values in all postoperative controls. We conclude, that the routine hiatoplasty with a polyvinyl mesh in laparoscopic antireflux surgery is a safe and effective procedure to prevent postoperative herniation of the wrap which leads to a better outcome than with simple sutures.

Functional outcome after LARS with routine hiatoplasty

Before LARS 3 months after LARS 1 year after LARS

DeMeester Score 62.6 8.9 7.9

LES pressure/mmHg 2.5 14.1 13.0