[Cardiopexy using the umbilical ligament of the liver in the treatment of gastro-esophageal reflux. Results of experience with 100 cases].

The authors report their experience of the surgical treatment of gastroesophageal reflux using a circular cardiopexy with the ligamentum teres (Rampal-Marchal's procedure) associated with a 180 degrees posterior fundoplication. 100 patients with severe reflux (76% oesophagitis) were operated on with this procedure over a 6 year period. Symptoms of reflux disappeared immediately in 99% cases, which corresponded to the healing of oesophagitis with 45 out of the 46 patients controlled with endoscopy, and to a significant increase of inferior sphincteric pressure (from 12 cm H20 to 24 cm H20). Objective controls by post prandial pHmetry evidenced persistent reflux with 4 patients, but 3 of them are totally free of symptoms. Operative mortality was 2%. Transient dysphagia was observed in 25% cases. 96 patients were reviewed with a mean follow up of 23 months. 3 clinical recurrence of reflux were observed (4%) but no oesophagitis was found on endoscopic controls with these 3 patients and none had to be reoperated on. Actuarial chance to remain free of recurrence was estimated at 96.6% up to 48 months according to the Kaplan-Maier's method. Cardiopexy with the ligamentum teres ensures the lengthening of the abdominal portion of the esophagus and anchors the antireflux assembly within the positive pressure environment of the abdomen in a strong and flexible way. It seems to be an advisable procedure for the treatment of GE reflux.