Laparoskopische Toupet-Fundoplicatio bei Patienten mit gastroösophagealer Refluxkrankheit und gestörter Ösophagusperistaltik

Abstract

LaparoscopicToupet Fundoplication in Patients with Gastroesophageal Reflux Disease and Impaired Esophageal Peristalsis In patients with gastroesophageal reflux disease and impaired esophageal body motility the Nissen fundoplication has been discussed controversially due to its relatively high dysphagia rate. It was the aim of the present cohort study to investigate mid- to long-term results of laparoscopic Toupet fundoplication in these patients. 126 Toupet fundoplications have been performed between 1994 and 2000 at the Department of General Surgery, University Hospital Innsbruck, and the Department of Surgery, Kaiserin-Elisabeth-Spital Vienna. The study population comprises 86 patients (62% male, 38% female, mean age 53 years) with complete postoperative evaluations. Upper gastrointestinal endoscopy, esophageal manometry, 24-hour pH-metry, and the assessment of clinical symptoms were carried out preoperatively and median 23 months postoperatively. Impaired esophageal peristalsis was defined manometrically by means of contraction amplitudes in the distal esophagus and the rate of simultaneous and interrupted waves. 70 patients (81%) were completely free of symptoms postoperatively; heartburn/regurgitation or esophagitis were present in 6 patients (7%). The rate of dysphagia decreased from 51% preoperatively to 9% postoperatively (p < 0.001). Esophageal peristalsis improved significantly: The contraction amplitudes increased (p < 0.001), and the rate of defective waves decreased (p < 0.0001). The lower esophageal sphincter pressure as well as the intra-abdominal sphincter length were significantly improved (p < 0.001). The Nissen fundoplication still represents the gold standard in antireflux surgery – if only due to the long-standing surgical experience. According to our results, the Toupet fundoplication seems to be the better procedure in patients with impaired esophageal peristalsis.

Vorgehensweise bei chronischer Refluxösophagitis

“…Bezüglich der Effizienz der Refluxreduktion bestehen nach mehreren Untersuchungen keine signifikanten Unterschiede zwischen einer 360°-Fundoplicatio (Nissen) und der partiellen Fundoplicatio. Allerdings wird von verschiedenen Autoren angegeben, dass die Dysphagierate bei der Hemifundoplicatio geringer als bei der Nissen-Fundoplicatio sei, dass allerdings die Langzeitergebnisse der Nissen-Fundoplicatio günstiger seien (2,5).…”