Impact of complete gastric fundus mobilization on outcome after laparoscopic total fundoplication

被引:53
作者
Blomqvist, A [1 ]
Dalenbäck, J [1 ]
Hagedorn, C [1 ]
Lönroth, H [1 ]
Hyltander, A [1 ]
Lundell, L [1 ]
机构
[1] Univ Gothenburg, Sahlgrenska Univ Hosp, Dept Surg, Gothenburg, Sweden
关键词
fundoplication; laparoscopy; Nissen-Rossetti fundoplication; gas bloat; dysphagia; gastroesophageal reflux disease; 24-hour pH monitoring; quality of life; endoscopy;
D O I
10.1016/S1091-255X(00)80092-X
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
With the objective of further optimizing the outcome of antireflux surgery, we have studied the importance of dividing the short gastric vessels when performing a laparoscopic total fundoplication. Ninety-nine consecutive patients with chronic gastroesophageal reflux disease (GERD) were enrolled in the trial. Forty-seven patients (25 men, age 52 +/- 1.6 years [mean +/- standard error]) were randomized to undergo a laparoscopic Nissen-Rossetti total fundic wrap with intact short gastric vessels, whereas 52 patients (29 men, 48 +/- 1.4 years) had complete division of these vessels. Quality of life was assessed by means of the psychological general well-being and gastrointestinal symptom rating scale indices. The 6- and 12-month follow-up data are reported. Two patients were converted to open surgery. Mobilization of the fundus significantly prolonged the operative time (120 vs. 104 minutes, P = 0.05); othernise the complication rates were similar in the two groups. Both procedures were equally effective in controlling gastroesophageal reflux at 6 and It months' postoperatively. Division of the short gastric vessels had no significant impact on the point prevalence of postfundoplication complaints at the given follow-up time points. Quality of life was significantly improved by both operative procedures and remained "normal" throughout the follow-up period. Dividing all short gastric vessels had no impact on the functional outcome during the first year of recovery after a total laparoscopic fundoplication.
引用
收藏
页码:493 / 500
页数:8
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