Laparoscopic Fundoplication In Treatment Of Gastro-Esophageal Reflux Disease

Fundoplication has been well proven to be an effective treatment for gastro-oesophageal reflux disease (GORD). In particular, laparoscopic Nissen fundoplication has been shown to achieve equivalent results to the conventional open procedure at both short-term and long-term follow-up. However, in some patients this procedure can be followed by unwanted persistent side-effects. These include dysphagia, inability to belch and vomit, abdominal bloating, and other gas-related problems, and these can occasionally impact significantly on the patient’s quality of life. To determine whether applying a laparoscopic anterior180partial fundoplication in patients undergoing surgery for reflux can reduce the risk of postoperative dysphagia or other adverse side effects, we enrolled patients in a prospective randomized double-blind trial which compared laparoscopic Nissen fundoplication with anterior180°partial fundoplication. A small cohort of patients present after antireflux surgery complaining of recurrent heartburn. Over two thirds of these patients will have a negative24-hr pH study. The aim of our study is to determine whether these patients have a functional disorder, and to examine the reproducibility of postoperative pH testing.A prospective analysis was carried out on a cohort of patients who had undergone a fundoplication and postoperative pH testing for recurrent heartburn. Patients were placed into two groups:All patients completed three questionnaires, and Group A patients were asked to undergo a second postoperative pH test.Both anterior180°partial and Nissen fundoplication are safe, effective and durable at late follow-up, and most patients are satisfied with their clinical outcome. Patients with recurrent heartburn and a negative pH study meet the criteria for functional dyspepsia, and some have associated symptoms of depression. Psychological factors may play a key role in their post-fundoplication outcomes. Reproducibility of24-hr pH testing in these patients is excellent. A second pH test to confirm initial results will be unnecessary in most patients.