Laparoscopy in the gastroesophageal junction.

Three years experience of laparoscopic surgery for treatment of gastroesophageal reflux, large paraesophageal hernia and morbid obesity is presented. One hundred and thirty-six patients with reflux esophagitis and 6 patients with large paraesophageal or combined hiatal hernias have been laparoscopically treated with hiatal hernias have been laparoscopically treated with hiatal hernia repair and a 360 degrees Rosetti (N = 109) or semitotal Toupet (N = 33) fundoplication. Sixteen patients with morbid obesity have been treated with laparoscopic placement of a variable band around the cardia. Twelve months follow-up is available for 74 of the esophageal reflux patients. 90% of the patients are completely satisfied. One patient has been reoperated due to recurrent reflux and one due to hiatal fibrosis. The cardia banded patients achieved the desired dysphagia to control food intake. Complication rates are low in all groups. Laparoscopic fundoplication, closure of large hiatal defects and cardia banding are feasible with low morbidity and comparable outcome to open surgery. Further studies are needed to investigate to what extent the laparoscopic technique is beneficial to the patient and cost effective.