Zacate-Otero T, Montiel-Jarquin A, Salazar-Ibarguen J, López-Colombo A

Language: Spanish
References: 16
Page: 57-61
PDF size: 93.21 Kb.

ABSTRACT

In 1956, Nissen described for the first time the technique that bears his name, which consists of a fundoplication using the posterior surface of the fundus around the distal oesophagus. In 1965, Nissen and Rosetti proposed a modification that consisted of fundoplication using the anterior surface of the stomach; however, the modifications took place only when it was possible to understand the physiology of the competency of the cardia. Antireflux surgery has made great advances in recent decades but despite this, complications have continued. Objectives: To review the records of all patients having antireflux surgery with Nissen technique in the Hospital de Especialidades del Centro Médico Nacional “M. Avila Camacho” during 1998, with the goal of evaluating complications, studying such variables as age, gender, type of complication, and when it occurred. Results: During the study period, there were 55 antireflux procedures performed: Nissen, 49 (89%), Nissen Rosetti, two (3.8%), and Toupet, four (7.2%). Of these, complications of Nissen technique were studied because of the more significant number of procedures; for this reason, they were divided into transoperatories, three, one perforated oesophagus, one perforated fundus, and one splenectomy, and post-operatives which were eventration in four patients, and one acute gastric distension, all surgically repaired. Secondary symptoms of the surgery occurred as follows: Dysphagia, 13 (26.53%), gastric distension, three (6.12%), inability to belch and vomit, four (8.16%), epigastric pain, five (10.20%), and distension and flatulence, nine (18.36%); in no case did reflux recur (0%). Two patients (4.08%) died, from mediastinitis and septic shock. In 25 patients (51.02%) antireflux effect was immediate and there were no further symptoms. Six months after surgery, 96% of patients had no evidence of reflux. Conclusions: We concluded that despite advances in surgical techniques, there continue to be complications in antireflux procedures; we must carry out a complete preoperation protocol including studies such as oesophagus-stomach-duodenum series, manometry of the oesophagus, 24-h pH measurement, endoscopy, radionuclide studies, endosonograph, and computed tomography to evaluate the anatomy and physiology of the region and based on this, to decide on the appropriate procedure. Additionally, we must see that our complications are within the ranges reported by other authors, that it is necessary to identify earlier serious complications to avoid death, and that it is necessary to perform an endoscopy 6 months after the procedure.

REFERENCES

1. Horgan S, Pellegrini C. Tratamiento qirúrgico de la enfermedad por reflujo gastroesofágico. Clínicas quirúrgicas de Norteamérica. Cir Esof 1997; 5: 1045-62.

2. Hanson DG, Kamel PL, Kahrilas PJ. Outcomes of antireflux therapy for the treatment of chronic laryngitis. Ann Otol Rhinol Laryngol 1995; 104:550-55.

3. Harding SM, Richter JE, Guzzo MR et al. Omeprazole to treat asthma. Am J Med 1996; 100: 395-504.

4. Pellegrini CA. Therapy for gastroesophageal refluxes disease: the new kid on the block. Am J Surg 1995; 180: 585-87.

5. Nissen R. Eine einfache operation zur beeinflussung der refluxesophagitis. Schweiz Med Wochenschr 1956; 86: 590-92.

6. Katz PO, Castell DO. Current medical treatment and indications for surgical referral for gastroesophageal reflux disease (GERD). Semin Thorac Cardiovasc Surg1997; 9(2): 169-72.

7. Geagea T. Laparoscopic Nissen’s fundoplication is feasible. Can J Surg 1991; 34: 313.

8. Bresadola V, Murgia AP, Zamboni P, Feo C, Liboni A, De Anna D, Pati MG. New directions in the surgical treatment of gastroesophageal reflux. Review of the literature. Annal Ital Chir 1997; 68(2): 213-8.

9. Fass R, Hixson LJ, Ciccolo ML, Gordon P, Hunter G, Rappaport W. Contemporary medical therapy for gastroesophageal reflux disease. Am Fam Phys 1997; 55(1): 295-12, 217-8.

10. Freedman J, Naslund E, Ganstrom L, Backman L. Biliary reflux can be a contributory cause of oesophagitis. Lakartidningen 1998; 95(38): 4086-90.

11. De Meester SR. Management of Barrett’s oesophagus free of dysplasia. Semin Thorac Cardiovasc Surg 1997; 9(3): 279-84.

12. Dent J. Gastro-oesophageal reflux disease. Digestion 1998; 59(5): 433-45.

13. Luostarinen M. Nissen fundoplication for reflux esophagitis. Long-term clinical and endoscopic results in 109 of 127 consecutive patients. Annal Surg 1993; 217(4): 329-337.

14. Thor K, Silander T. A long-term randomized prospective trial of the nissen procedure versus a modified toupet technique. Ann Surg 1998; 210(6): 719-724.

15. Hunter J, Swanstrom L, Waring P. Dysphagia after laparoscopic antireflux surgery. The impact of operative technique. Ann Surg 1996; 224(1): 51-57.

16. Rossetti M, Allgower M et al. Fundoplication for treatment of hiatal hernia. Progr Surg 1973; 12: 1-21.