Laparoscopic Toupet fundoplication is an inadequate procedure for patients with severe reflux disease

摘要: Recently we have shown that laparoscopic Toupet fundoplication is associated with a high degree of late failure when employed as primary treatment for gastroesophageal reflux disease (GERD). This study defines preoperative risk factors predispose patients to failure. Data from 48 objective follow-up performed part prospective long-term outcomes project (24-hour pH monitoring, manometry, and esophagogastroduodenoscopy [EGD] at 6 months, 3 years, years) was analyzed. Preoperative studies documented postoperative (n = 22), defined an abnormal 24-hour (DeMeester score >14.9), were compared normal 26). Outcomes assessed mean 22 months (range 18 37 months) postoperatively. Of the in group, 16 (77%) symptomatic majority (64%) had resumed proton pump inhibitor therapy. indices severe significantly more prevalent group including very low or absent lower esophageal sphincter (LES) pressure on biopsy-proved Barrett's metaplasia, presence stricture, grade III greater esophagitis, DeMeester than 50 ambulatory testing. Comparison pre- manometric analysis LES revealed adequate augmentation both groups there no wrap disruptions by EGD indicating most likely occurring through intact group. Esophageal dysmotility present before surgery four nonrefluxing three failures. Intact wraps noted herniated eight patients, all whom reflux. Laparoscopic rate clinically Surgery fail GERD uncomplicated mild disease. A 86% sensitive predicting our patient population. should not be used standard antireflux procedure particularly complicated