Lopes L R, Brandalise N A, Andreollo N A, Leonardi L S
Grupo de Cirurgia do Esôfago-Estômago-Duodeno, Disciplina de Moléstias do Aparelho Digestivo, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, SP.
Rev Assoc Med Bras (1992). 2001 Apr-Jun;47(2):141-8. doi: 10.1590/s0104-42302001000200033.
Gastroesophageal reflux disease is highly common worldwide and surgical treatment is being indicated more frequently. Currently, laparoscopic is the access of choice and several antireflux techniques may be used. We prefer a modified Nissen technique.
To analyze preoperative clinical and functional parameters and compare with postoperative outcome of a modified valve technique performed by laparoscopy.
A group of 59 patients underwent laparoscopic modified Nissen valve. Preoperative diagnosis was made by radiological contrast exams and endoscopy in all patients. Esophagus manometry was performed in 35 patients and scintigraphy scan in 15 patients. Complicated esophagitis occurred in 54.2%, with 21 (35.6%) patients presenting a Barrett's epithelium. Laparoscopic surgery was performed in all patients with no conversion to open surgery, with an average time of 123.9 minutes.
There were no intraoperative complications. Hospital discharge occurred in an average of 47.6 hours. Symptoms as dysphagia, pain, regurgitation and flatus occurred in 48.1% of the patients in the first thirty days. Average follow-up was 20.8 months. Postoperative radiological, endoscopic, manometric and scintigrafic scan exams showed a significant improvement, as well as clinical assessment using Visick's classification, which showed excellent and good results in 93.1% of the patients.
Comparative analysis of clinical assessment and exam results lad us to conclude that modified Nissen surgery by laparoscopic access corrects gastroesophageal reflux in most patients followed-up.
