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Chirurgia 2004 June;17(3):89-94


language: Italian

Does the Nissen-Rossetti fundoplication still preserve its actuality?

Fimmanò A., Coppola Bottazzi E., Cirillo C., De Palma G. D., Vittoria I.


Aim. The aim of this study, based on personal experience and on a critical review of the last decade scientific literature is to give a contribution to the formulation of valid guidelines in the therapy of gastro-esophageal reflux disease (GERD). In spite of continuous therapeutical (anti-H2, PPI, Alginates, etc.) and nutritional progresses, also at present, GERD preserves its nosological and epidemiological identity. Due to ubiquitary diffusion of minimally invasive techniques, the rate of operated patients for GERD seems to be increased, due to a larger availability of individuals to undergo a less traumatic operation, or, perhaps, to some extensions to surgical therapy. The increased rate of interventions and the surgical approach caused the re-appearance of some intolerant complications (i.e. a persistent dysphagia) that disappeared when performing open surgery. The laparoscopic way, suggested also to prefer partial gastric plication instead of total plasty.
Methods. In this study we have enrolled 114 patients from October 2000 to October 2003. All these patients were submitted to endoscopy, esophageal manometry, radiography and 24 h pH-metry.
Results. Medical therapy together with a dietary and behavioural protocol led to good results in 98/114 patients (86%). We performed surgical treatment in 12 of the 16 remaining patients; 2 patients died for natural causes, the last 2 avoided follow-up. Of the 12 operated patients, 10 were submitted to a 360° fundoplication (Nissen-Rossetti procedure) and only 2 patients to anterior Dor's plication. No complications were observed: no deaths, only 1 temporary (10 days) dysphagia, no cases of persistent dysphagia and no reinterventions. All patients continued medical therapy from 30 to 180 days; no patient is pharmacological dependent at 1 year follow-up.
Conclusion. These results suggested an unchanged validity of the 360° Nissen-Rossetti procedure and a more safe surgical approach, performing ''open surgery'', in the GERD surgical treatment.

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