Abstracts
1998 Digestive Disease Week
#2326
IMPROVED FUNCTIONAL OUTCOME AFTER LAPAROSCOPIC FUNDOPLICATION BY COMPLETE GASTRIC FUNDUS MOBILIZATION. Jan Dalenbäck, Hans Lönroth, Anne Blomqvist, Lars Lundell. Department of Surgery, Sahlgrenska University Hospital, University of Gothenburg, SWEDEN.
Technical factors might be of importance when optimising the functional outcome after fundoplication operations. One issue, discussed at length, has been whether all short gastric vessels have to be transsected to allow the construction of a "floppy" total fundic wrap. This particular question has been addressed in a prospective, randomised clinical trial.
Material and Methods: 100 consequtive chronic gastro-esophageal reflux (GERD) patients were enrolled. 50 patients (24/26 male/female, mean age 52 ± 1.7 years) were randomised to a laparoscopic Nissen-Rossetti total fundic wrap without division of the short gastric vessels using the mobile anterior portion of the proximal stomach to encircle the oesophagus. The other 50 patients (26/24 male/female, 49 ± 1.5 years) were randomised to a total fundic wrap after complete division of all short gastric vessels from the aboral pole of the spleen to the left crus. A large bougie was used in the oesophagus to ensure a loose, "floppy" wrap. Two patients were converted to open procedures; one due to adhesions after cholecystectomy and one due to subcutaenous emphysema while all other operations were performed laparoscopically. All patients had a crural repair and the wrap was made 1.5-2.0 cm in length.
Results: The overall results are outlined (functional results 12 months postop) in the table below.
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Mobilized fundus
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Intact vessels
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p-value
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Op time (min)
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123 ± 5
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104 ± 5
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< 0.05
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Complications (n)
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6
|
8
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n.s.
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Failures (n)
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1
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6
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< 0.001
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GERD controlled
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94%
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97%
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n.s.
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Ability to belch
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86%
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56%
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< 0.003
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Dysphagia
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20%
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36%
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< 0.02
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Gasbloat
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57%
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71%
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n.s.
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GERD was equally well controlled in both groups as assessed by clinical evaluation and 24 hour pH-metry.
Conclusion: It is advisable to mobilise the gastric fundus by division of all short gastric vessels when performing a total laparoscopic wrap since fundic mobilisation is followed by less obstructive complaints and also an improved ability to vent air from the stomach.
Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.
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