2005 Abstracts: Re-Implantation of the Phrenoesophageal Ligament During Laparoscopic Nissen Fundoplication
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Re-Implantation of the Phrenoesophageal Ligament During Laparoscopic Nissen Fundoplication
Samir Mehta, Andrew Hindmarsh, Richard Lowndes, Michael Rhodes, Norfolk and Norwich University Hospital, Norwich, Norfolk, United Kingdom (Great Britain)
Introduction
It is believed by many anatomists that the phrenoesophageal ligament is an important component of the inferior esophageal sphincter and thereby plays a role in gastroesophageal competence. There has been little mention in the past on whether its reconstruction during Laparoscopic Nissen Fundoplication has any influence upon outcome. This study evaluated clinical outcome and physiological measurements in patients with or without re-implantation of the phreno-oesophageal ligament. Methods 204 patients underwent Laparoscopic Nissen Fundoplication after 24 hr pH testing and manometry. Post-operatively they were invited to have repeat physiology measurements at 4 months and clinic follow-up at 6 months. Results 98 patients underwent re-implantation of the phrenoesophageal ligament (Group 1) and 106 did not (Group 2). Age, severity of reflux disease and size of hiatal hernia were similar in the 2 groups. There was no significant difference between groups in either mean operating time or morbidity. 61% of patients succesfully completed post-operative physiology: Percentage time pH<4 improved from 12.7% to 1.6% in Group 1 and from 11.2% to 1.9% in Group 2 (n.s.). Mean lower esophageal sphincter pressure improved from 5.6 to 18.0mmHg in Group 1 and from 5.9 to 17.1mmHg in Group 2 (n.s.). There was no significant difference in the position of the neo-sphincter relative to the diaphragm between groups (Chi-squared p=0.24). At 6 months, prevalence of dysphagia and of recurrent reflux were similar in the 2 groups. Conclusion Re-implantation of the phrenoesophageal ligament has no measurable effect on physiological parameters at 4 months or on clinical outcome at 6 months.
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