Laparoscopic partial fundoplication vs laparoscopic Nissen-Rosetti fundoplication

Abstract

Laparoscopic partial fundoplication is as effective as laparoscopic Nissen-Rosetti fundoplication, with a higher satisfaction rate and fewer side effects. Measuring for wrap and hiatus size eliminates the need for and risk of using stiff dilators. By utilizing cosurgeons and currently available technology, cost, operative time, hospital time, and complications can be reduced to a finite minimum.

Evidence-Based Appraisal of Antireflux Fundoplication

“…8,89,90 Surgeons began to perform partial fundoplications more frequently, 11,91 and the results of several nonrandomized trials did not confirm this hypothesis. [92][93][94] On the other hand, some authors still cast serious doubts regarding the effectiveness of partial fundoplication on the control of reflux, 93,[95][96][97] and others suggest that a floppy Nissen can be effective even in patients with defective esophageal peristalsis. 98,99 In this analysis (Table 6), partial fundoplication appeared to be a better procedure than total fundoplication, showing similar operative time, morbidity and recurrence rates, but a significantly reduced rate of reoperations for failure (1.6% versus 9.6%), mainly due to postoperative dysphagia (10.1% versus 16.8%).…”

Anterior partial fundoplication for gastroesophageal reflux disease

“…This operation is, however, associated with a number of postoperative complications, in particular with a relatively high incidence rate of dysphagia; incidence rates ranging from 5% to 43% have been reported following conventional fundoplication [8,9,10], requiring reoperation for dysphagia in up to 25% of patients [5]. A major cause of dysphagia is the creation of a 360°wrap [11,12,13,14,15,16,17,18,19]. This has led to the use of procedures entailing the creation of a partial wrap.…”

The Short Esophagus: Pathophysiology, Incidence, Presentation, and Treatment in the Era of Laparoscopic Antireflux Surgery

“…[22][23][24] Such thinking contradicts the preponderance of evidence from pathologic specimens, data from animal models, known responses of tissues to burns with contracture formation, and the incidence of surgical failures after fundoplication surgery. 2,9 Other entities associated with esophageal shortening include type III paraesophageal hernias, sarcoidosis, Barrett's metaplasia, caustic ingestion, scleroderma, and Crohn's disease, all of which can result in a profound inflammatory reaction with significant cephalad displacement of the gastroesophageal junction (GEJ).…”

“…In a review of the open and laparoscopic literature, the frequency of esophageal shortening ranges widely from the 60% reported by Pearson and Todd 25 to 0% reported by Hill et al 23 and some laparoscopic series. 22 In fact, at one point, Pearson and Todd described all patients undergoing an antireflux procedure as needing a Collis- Nissen. 25 A problem with the series reporting extremes of incidence is that none describes individual patient assessment using a clear definition of a short esophagus (namely, a GEJ that cannot be surgically mobilized to lie Ͼ2.5 cm below the hiatus without tension).…”