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LAPAROSCOPIC ANTERIOR 90° FUNDOPLICATION FOR REFLUX OR LARGE HIATUS HERNIA
Author(s) -
Shukri Mohammed J.,
Watson David I.,
Lally Carolyn J.,
Devitt Peter G.,
Jamieson Glyn G.
Publication year - 2008
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2007.04385.x
Subject(s) - medicine , reflux , dysphagia , surgery , nissen fundoplication , hernia , prospective cohort study , laparoscopy , disease
Anterior 90 ° partial fundoplication has been proposed as technique to minimize the risk of side‐effects following surgery for gastro‐oesophageal reflux. We have applied this approach for the treatment of gastro‐oesophageal reflux and/or large hiatus hernias. Previous studies have shown that this type of procedure can achieve good control of reflux, with fewer side‐effects. However, only short‐term follow up has been reported. In this study, we determined later clinical outcomes in patients who have undergone this procedure. All patients who underwent a laparoscopic anterior 90 ° partial fundoplication surgery were identified from a database, which collected prospective clinical data. Patients completed a standardized questionnaire 3 months after surgery and then yearly to assess clinical symptoms of reflux and postoperative side‐effects. Between February 1999 and January 2006, 246 patients underwent surgery – 74 in conjunction with repair of a large hiatus hernia and 172 for reflux. Three patients underwent further surgery within 2 days of the original procedure (one for repair of a perforated oesophagus) and four underwent later surgical revision (reflux 3, dysphagia 1). Clinical follow‐up data were available for 98% at 3–84 months (median 36). Most patients had effective relief of reflux symptoms at up to 3 years follow up. Dysphagia scores improved following surgery. The magnitude of this improvement was greater in patients with large hiatus hernias. More than 80% of the patients were able to belch normally at all time points after surgery and most were highly satisfied with the overall outcome. Satisfaction scores were higher following repair of a large hiatus hernia. The clinical results of laparoscopic anterior 90 ° fundoplication for either reflux or as part of repair of a large hiatus hernia are encouraging, although longer‐term follow up is required to confirm durability of reflux control.