Abstract
BackgroundThe gastro-esophageal reflux disease (GERD) is one of the most frequent disease of the upper gastro-entheric tract. Surgical treatment is reserved to selected patients, affected by severe forms of disease and/or without compliance to medical therapy.In 95%-60% of the patients submitted to surgical antireflux intervention, a notable improvement of the quality of life is observed.Functional evaluations performed on pre and post – surgical pHmetric and manometric examination have provided new acquisitions about improvements in the restoration of anatomical and functional integrity of the esophagus-gastric antireflux barrier.Methods45 elderly patients with GERD were recruited in a 27 months period. All patients were subjected to laparoscopic Nissen-Rossetti 360° fundoplication. The subjects had a pre-surgical evaluation with:• 24 hours pHmetry,• esophageal manometry,The same evaluation was repeated 1 month and 6 months after surgical intervention.ResultsIn our series all patients get benefit from surgical treatment, with an improvement of pHmetric and manometric parameters and a regression of complications of GERD such as Barrett's metaplasia. In 8.33% of patients a PPI therapy was necessary, after the surgical intervention, to control symptoms.ConclusionsThe role of surgery in GERD concerns selected patients. Nissen-Rossetti mini-invasive approach is performed with an acceptable percentage of complications (3%-10%). This technique is associated with a good control of GERD symptoms in a short and middle term and with an improvement of functional parameters, such as pHmetric and manometric.
Highlights
The gastro-esophageal reflux disease (GERD) is one of the most frequent disease of the upper gastro-entheric tract
This technique is associated with a good control of GERD symptoms in a short and middle term and with an improvement of functional parameters, such as pHmetric and manometric
The patients have been preliminarily submitted to a 24 hours pH-metry and to an esophageal manometry; before pHmetric and manometric examinations, patients had to suspend at least for a week the assumption of antisecretive and antiacid drugs, and stop the assumption of prokinetic drugs and medicines that could interfere with the basal tone of the lower esophageal sphincter (LES) at least 24 hours before the investigations [9,13,14]
Summary
The gastro-esophageal reflux disease (GERD) is one of the most frequent disease of the upper gastro-entheric tract. In 95%-60% of the patients submitted to surgical antireflux intervention, a notable improvement of the quality of life is observed. GERD represents the most frequent disease of the upper gastro-enteric tract: the prevalence in elderly patients is 10%-20% [1,2]. Patient with evidence of severe esophageal lesions (ulcerations, stenosis or Barrett metaplasia) and incomplete symptomatological resolution or recurrence under medical therapy, patient with long duration symptoms or those of young age in which the symptoms persists, should be considered for surgical intervention [8,9,10,11,12]. In the 90%-95% of the patients submitted to surgical antireflux intervention , the resolution of heartburn and regurgitation with notable improvement of quality of the life is observed [11,12]. 3-10% of patients shows complications; a lot of complications are minimal and related to surgical interventions, others are reported to the techniques or to the approach, such as post-operative disphagy (reported in 20% of the patients) [12]
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