FA07.05: VLS ONE-WAY VALVE: A MINIMALLY INVASIVE SURGERY FOR GASTROESOPHAGEAL REFLUX

Abstract

Abstract Background Fundoplication, the standard antireflux surgery, suffers from the risks of side effects; to improve the results an alternative surgery, less invasive and more effective, was proposed by Longo. The aim of our study is to evaluate whether the technique of the ‘anterior one-way valve’ has resulted in lower complications and better functional results than total or partial fundoplication. Methods Between 2004 and 2009, 70 patients were operated with the Longo technique in Vienna. The technique consists of the transversal invagination of the anterior gastric wall: from the Z line to 8–10 cm caudally and from the lesser curvature to the angle of His. An anti-reflux valve, dome-shaped, is obtained on the cardias. An anterior hiatoplasty is added in case of diaphragmatic hiatus dilatation. The one-way valve impedes the reflux and at the same time it doesn’t cause gas-bloat syndrome or dysphagia. Moreover, the technique pulling down the esophagus in the abdominal cavity, prevents the hiatal hernia relapse. Results No patient required redo-surgery, presented a gas-bloat syndrome in the perioperative phase and after a long interval, neither symptoms of dysphagia at long terms. All the patients showed a general improvement in QoL up to 40.3%. The intervention reduced esophageal acid exposure and the esophagitis improved in all the patients. Patients with GERD recurrence at 5 years showed in 1 case grade B esophagitis and in 2 cases injuries attributed to grade A. Conclusion The technique of the anterior one-way valve creates a one-way valve system without any interference on the dynamics of the LES, allowing both the relaxation after swallowing, with almost no postoperative dysphagia, and TLESR with inherent possibility of belching and vomiting. The results are effective on the general state of health of the patients and on the objective check of gastroesophageal reflux endoscopically detected. The advantages of this new approach are made evident by the simplicity and speed of the operation associated with a mortality rate of 0%, low morbidity, no gas bloat syndrome or dysphagia. Disclosure All authors have declared no conflicts of interest.