Antireflex surgery in the laparoscopic era

David I. Watson, Glyn Jamieson

Research output: Contribution to journalArticle

159 Citations (Scopus)

Abstract


Background

The recent development of laparoscopic techniques for fundoplication has created renewed interest in surgery for gastro‐oesophageal reflux disease, leading to reports of large clinical series from many centres. However, controversy remains about technical aspects of laparoscopic antireflux surgery, with no consensus yet reached about a standard operative technique. It is important, therefore, to reassess critically the results of laparoscopic surgery for reflux disease, so that its current status can be determined.
Methods

Published outcome studies for laparoscopic antireflux surgery, as well as selected studies from the era of open antireflux surgery, were reviewed to assess outcomes.
Results

The results of case series for laparoscopic antireflux surgery with short‐ and medium‐term follow‐up, as well as the early results of randomized trials, confirm that this approach reduces the early overall morbidity of surgery for reflux disease. However, certain complications may be more common, for instance paraoesophageal hiatus herniation, pneumothorax and oesophageal perforation, requiring surgeons to use specific strategies which can help to avoid these problems. Published studies and trials do not support the routine or selective application of a posterior partial fundoplication technique or routine division of the short gastric vessels during Nissen fundoplication.
Conclusion

At present, a short loose Nissen fundoplication performed laparoscopically, with or without division of the short gastric vessels, is an appropriate surgical approach for gastro‐oesophageal reflux disease. However, long‐term outcomes following laparoscopic antireflux surgery will not be available for some years, and must be awaited before the final status of the various laparoscopic techniques can be confirmed.
Original languageEnglish
Pages (from-to)1173-1184
Number of pages12
JournalBritish Journal of Surgery
Volume85
Issue number9
DOIs
Publication statusPublished - Sep 1998
Externally publishedYes

Keywords

  • Laparoscopy
  • antireflux surgery
  • fundoplication
  • gastro-oesophageal reflux disease

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