Original article: general thoracic
Barrett's esophagus: the role of laparoscopic fundoplication

Presented at the Poster Session of the Thirty-ninth Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 31–Feb 2, 2003.
https://doi.org/10.1016/S0003-4975(03)01352-3Get rights and content

Abstract

Background

To review our early operative results and endoscopic findings after laparoscopic fundoplication for Barrett's esophagus (BE).

Methods

From January 1995 through December 2000, 49 patients with BE (35 men and 14 women) underwent laparoscopic antireflux surgery. Median age was 54 years (range, 28 to 85 years). No patient had high-grade dysplasia; 6, however, had low-grade dysplasia. All 49 patients had gastroesophageal reflux symptoms. Heartburn was present in 41 patients (84%), dysphagia in 16 (33%), epigastric or chest pain in 9 (18%), and other symptoms in 16 (33%). A Nissen fundoplication was performed in 48 patients and a partial posterior fundoplication in 1. Forty-one patients (84%) had concomitant hiatal hernia repair.

Results

There were no deaths. Complications occurred in 2 patients (4%). Follow-up was complete in 48 patients (98%) and ranged from 1 to 81 months (median, 29 months). Functional results were classified as excellent in 33 patients (69%), good in 9 (19%), fair in 5 (10%), and poor in 1 (2%). Thirty-three patients (67%) underwent postoperative surveillance esophagoscopy with biopsy. Nine patients (18%) had total regression of BE and 3 (6%) had a decrease in total length. In the 6 patients with preoperative low-grade dysplasia, dysplasia was not found in 4, remained unchanged in 1, and progressed to in situ adenocarcinoma in 1.

Conclusions

Laparoscopic fundoplication is effective in controlling symptoms in the majority of patients with BE. While disappearance of BE may occur in some patients, the possibility of developing esophageal adenocarcinoma is not eliminated by laparoscopic fundoplication. Therefore, endoscopic surveillance should continue.

Section snippets

Material and methods

Between January 1995 through December 2000, 82 patients with BE underwent a surgical antireflux procedure at the Mayo Clinic in Rochester, Minnesota. A laparoscopic procedure was performed in 49 of these patients and they form the basis of this report. Our surgical technique for laparoscopic antireflux procedure (LARP) has been previously described 1, 2.

The records of these patients were retrospectively analyzed for age, gender, symptoms, diagnostic evaluation, indications for operation,

Results

The patients were composed of 35 men and 14 women. Median age at the time of LARP was 54 years (range, 28 to 85 years). All patients were symptomatic and included heartburn in 41 (84%), dysphagia in 16 (33%), epigastric or chest pain in 9 (18%), and other symptoms in 16 (33%). No patient had previous antireflux surgery.

All patients underwent preoperative esophagogastroduodenoscopy and all had biopsy proven BE. The BE was circumferential in 28 patients (57%) and patchy in 21 (43%). The median

Comment

Barrett's esophagus is the condition in which columnar epithelium replaces the squamous epithelium that normally lines the distal esophagus. This condition develops as a result of reflux of gastric, biliary, and pancreatic fluids into the esophagus, which eventually damages the squamous epithelium. Subsequent healing occurs through a metaplastic process in which columnar cells replace squamous ones, with the end-result that this specialized intestinal metaplasia predisposes patients to

References (28)

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