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2006 Abstracts: To divide or not to divide the short gastric vessels? A question with an answer after 10 years of follow up
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To divide or not to divide the short gastric vessels? A question with an answer after 10 years of follow up
Engstrom Cecilia1, Jalal Mardani1, Hans Lonroth1, Lars Lundell2; 1Dept of Surgery, Sahlgrenska University Hostpital/SS, Goteborg, Sweden; 2Dept of Surgery, Karolinska Insitutet, Stockholm, Sweden

Background and aim Laparoscopic Nissen fundoplication is the most common antireflux operation. Problems with side effects remain such as dysphagia and gas bloat. In order to minimise those division of the short gastric vessels has been proposed. We and others have offered no evidence to support the routine use of this when evaluated during the first postoperative year. Hereby the long-term (10 years) consequences have been determined. Patients and methods Originally 99 patients were enrolled in a randomised clinical trial (RCT) evaluating the part of short gastric vessel division on the functional outcome after a laparoscopic Nissen. Forty- seven had their vessels intact (group I) and 52 had them all divided (group II). These patients were now re-evaluated by use of validated questionnaires and the patients Quality of Life (QoL) was assessed by use of psychological general well-being index (PGWB) and gastrointestinal symptom rate scale (GSRS) instruments. Results Thirteen patients were lost to follow up of whom 7 had died, 3 had moved abroad and 3 were lost to follow up. We were unable to reveal any difference in GERD control based on symptoms. Moreover postfundoplication complaints were reported in similar frequencies in both groups. Accordingly QoL was quite comparable as well except for a total PGWB score, which favoured those having the short gastric vessels intact. Conclusion The impact of dividing the short gastric vessels at the time of constructing a floppy laparoscopic Nissen has been debated. Short-term and now also long-term grade A evidence shows that this is not an essential part of the procedure.


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