5. Laparoscopic Gastroesophageal Valvuloplasty: A New Procedure for the Treatment of Gastroesophagel Reflux Disease.
Two Years Follow up in 60 Patients.

Farid Gharagozloo, Stanley Benjamin, Mohammad Pourshahmir, Karen Deters, Gregory D. Trachiotis, James L. Cox

Georgetown University Medical Center

Washington, D.C.

Gastroesophageal reflux disease (GERD) is the most common disorder of the upper gastrointestinal tract in humans. During the past five years a series of laboratory and clinical investigations in our institution which were aimed at defining the normal antireflux mechanism have resulted in the design of a new minimally invasive procedure for the treatment of GERD, Gastroesophageal Valvuloplasty. During this procedure the esophageal hiatus is closed anteriorly and a spiral valve is created at the gastroesophageal junction. The valve is fashioned by placing a series of sutures from the greater curvature to the lesser curvature of the stomach which in turn pass from the highest point to the lowest point of the hiatal closure, respectively. Two year follow up was completed in 60 patients who underwent this procedure from September 1992, to September 1995. There were 32 men, 28 women with an age range 12-75 years (median 48). All patients were on a protonpump inhibitor. All patients underwent preoperative endoscopy, manometry, and 24-hour pH testing. Indications for surgery were: esophagitis (10) Barrett’s (two), Pulmonary complications (six), and intractability(42). The mean OR time was 100+/2.4 minutes. The mean hospital stay was 22+/-5 hours. All patients were discharged on a regular diet. Thirty-six of 60 patients experienced slight dysphagia to solids for up to one week. Symptomatic relief was assessed on a Visick grading system at two weeks, and three, 12, and 24 months. The patients filled a Symptom Questionnaire at three, 12, and 24 months. At three months, or if symptomatic thereafter, patients underwent endoscopy, manometry and 24-hour pH testing.
 
 

The patient with Visick Grade III had Scleroderma and required additional medical therapy. Clinical Scoring from the Symptom Questionnaire decreased from preoperative level of 11.8+/-1.1 to 0.6+/0.2 at 24 months. (P<0.05). No patients reported dysphagia or "gas bloat" syndrome. On 24-hour pH testing the mean total acid exposure (percent time pH<4) decreased from a preoperative level of 9.2 "/-0.6 to 0.5 +/-0.2 percent postoperatively (p<0.05). Gastroesophageal Valvuloplasty was found to relieve reflux in 98 percent of the patients in the intermediate term without any of the devastating complications associated with other antireflux procedures. The results may be an argument to broaden the indications of this procedure for the surgical therapy of GERD.