LAPAROSCOPIC ANTIREFLUX SURGERY - 11/09/11
Résumé |
The modern history of surgery for gastroesophageal reflux (GER) is rich. Since the 1930s, GER has been associated with hiatal hernia. The first operations were designed to correct the anatomic abnormalities by reducing the hernia and closing the crura. This led to a 50% recurrence rate of reflux symptoms, so these procedures were abandoned.1 Nissen first used a gastric fundoplication in 1936 to protect the anastomosis after distal esophagectomy in a patient with a deeply penetrating esophageal ulcer.34 Endoscopy 16 years later revealed no esophagitis. He performed his first fundoplication for GER in 1955, a 360-degree 6-cm fundic wrap around the distal esophagus.35 Belsey published his first series of the Belsey Mark IV transthoracic fundoplication 5 years later with very good results.21 In 1965 Nissen and Rosetti published a report of an anterior fundal wrap of the esophagus to be used in extremely obese patients.36 Rosetti and Hell developed a 360-degree fundoplication without taking down the short gastric vessels.9 In 1985 Donahue published the advantages of using the “floppy” fundoplication to help avoid the gas bloat syndrome 12 and in 1986 DeMeester described a fundoplication technique with only 1 to 2 cm of the fundus around the distal esophagus to help prevent gas bloat and dysphagia.11 Other modifications have included narrowing the esophageal hiatus and several other partial fundoplications, as proposed by Dor in 1962, 13 Toupet in 1963, 44 Watson in 1991, 47 and the Collis Nissen procedure for shortened esophagus in 1957.14
The easiest fundoplication to perform and teach, as well as the most common operation performed in the United States, is the Nissen procedure, and this was the first to be performed laparoscopically in 1991.19 Since then there have been several large series of laparoscopic fundoplication showing safety, efficacy, good quality of life, short hospital stay, and early return to work. As well, a cost savings over open surgery has been demonstrated in some series.10, 30 The long-term results of laparoscopic fundoplication will not be known for another 5 to 10 years.
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| Address reprint requests to John G. Hunter, MD, FACS, Emory University Hospital, Department of Surgery, Room H124C, 1364 Clifton Road, NE, Atlanta, GA 30322 |
Vol 76 - N° 3
P. 437-450 - juin 1996 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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