Abstract
ABSTRACT Background: Gastroesophageal reflux disease is defined by the abnormal presence of gastric content in the esophagus, with 10% incidence in the Western population, being fundoplication one treatment option. Aim: To evaluate the early (six months) and late (15 years) effectiveness of laparoscopic fundoplication, the long term postoperative weight changes, as well as the impact of weight gain in symptoms control. Methods: Prospective study of 40 subjects who underwent laparoscopic Nissen’s fundoplication. Preoperatively and early postoperatively, clinical, endoscopic, radiologic, manometric and pHmetric evaluations were carried out. After 15 years, clinical and endoscopic assessments were carried out and the results compared with the early ones. The presence or absence of obesity was stratified in both early and late phases, and its influence in the long-term results of fundoplication was studied, measuring quality of life according to the Visick criteria. Results: The mean preoperative ages, weight, and body mass index were respectively, 51 years, 69.67 kg and 25.68 kg/m2. The intraoperative and postoperative complications rates were 12.5% and 15%, without mortality. In the early postoperative period the symptoms were well controlled, hernias and esophagitis disappeared, the lower esophageal sphincter had functional improvement, and pHmetry parameters normalized. In the late follow-up 29 subjects were assessed. During this period there was adequate clinical control of reflux regardless of weight gain. In both time periods Visick criteria improved. Conclusion: Fundoplication was safe and effective in early and late periods. There was late weight gain, which did not influence effective symptoms control.
Highlights
Gastroesophageal reflux disease (GERD) is defined by the abnormal presence of gastric content above the lower esophageal sphincter (LES), causing a variable spectrum of symptoms and complications[30]
Postoperative weight gain may lead to fundoplication failure to contain reflux due to the increase in intra-abdominal pressure and modification of the gastroesophageal pressure gradient[14,23]
The objectives of this study were to evaluate the safety of laparoscopic fundoplication, its effectiveness in the early and late (15 years) control of reflux symptoms, and the influence of postoperative weight gain on late reflux control
Summary
Gastroesophageal reflux disease (GERD) is defined by the abnormal presence of gastric content above the lower esophageal sphincter (LES), causing a variable spectrum of symptoms and complications[30]. It affects approximately 10% of the Western population[18,19]. Postoperative weight gain may lead to fundoplication failure to contain reflux due to the increase in intra-abdominal pressure and modification of the gastroesophageal pressure gradient[14,23] In this case, a new surgery may be necessary to control weight and preserve the anti-reflux mechanism. The objectives of this study were to evaluate the safety of laparoscopic fundoplication, its effectiveness in the early (six months) and late (15 years) control of reflux symptoms, and the influence of postoperative weight gain on late reflux control
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