Dysphagia and Clinical Outcome after Laparoscopic Nissen or Rossetti Fundoplication: Sequential Prospective Study

Abstract

Laparoscopic fundoplication represents the most widely used operation in the surgical treatment of gastroesophageal reflux disease (GERD). Besides being operator-dependent, the clinical outcome (efficacy and side-effects) seems also to be dependent on the specific surgical technique. In this prospective trial we compared the results of two groups of patients who were submitted sequentially to the Rossetti or Nissen fundoplication procedure. Dysphagia, other side effects, and clinical outcome were evaluated early after surgery and at 6 and 12 months after the operation. Although both procedures were clinically effective, there was a significant trend toward less postoperative dysphagia in the Nissen group. In these patients the incidence of early dysphagia was significantly lower than that observed in those submitted to the Rossetti fundoplication. In addition, Nissen patients experienced a significantly smaller number of days with dysphagia. One year after surgery, however, the two procedures proved equally successful without any significant difference in dysphagia incidence. Complete fundic mobilization should therefore be advised to reduce the incidence of early troublesome dysphagia.

Does the learning phase influence the late outcome of patients with gastroesophageal reflux disease after laparoscopic fundoplication?

“…Short gastric vessels were not divided in our patients, according to Rossetti's technique, and this could potentially be responsible for this troublesome side effect. Indeed, although two well-known randomized trials demonstrated that it is possible to achieve tension-free wraps and equally low percentages of dysphagia without division of the short gastric vessels [3,32], we [7] found that after the original Nissen procedure (in which full mobilization of the fundus is achieved), the incidence of dysphagia and the occurrence of dysphagia-free days are significantly lower.…”

“…The preoperative workup for all patients included an upper gastrointestinal (GI) x-ray, upper GI endoscopy, esophageal manometry, and 24-hr esophageal pH recording, as previously detailed [7]. Esophagitis grading was done according to the Savary-Miller endoscopic grading system [22].…”

Obesity Is Not a Contraindication to Laparoscopic Nissen Fundoplication

“…In most patients undergoing laparoscopic Nissen fundoplication, postoperative dysphagia is transient; however, persistent dysphagia remains a clinically significant problem. 18,19 Patients with persistent exacerbation of dysphagia after fundoplication were more than three times more likely to report an overall outcome score of fair or poor or to respond that they would not be willing to repeat the operation. In other words, patients with dysphagia were more likely to state that they would not undergo laparoscopic fundoplication again if they had known then (i.e., before fundoplication) what they know now.…”

Quality of life for patients with gastroesophageal reflux disease 2 years after laparoscopic fundoplication

“…In all patients, before pH 3 -metry, the lower esophageal sphincter was located by esophageal manometry, using a medical measurement system (MMS) (Medical Measurement System, Enschede, The Netherlands), as previously described [4].…”