caa a22 4500 475781139 CHVBK 20180406123644.0 cr unu---uuuuu 170329e20000501xx s 000 0 eng 10.1007/s004640020079 doi (NATIONALLICENCE)springer-10.1007/s004640020079 A comparison of laparoscopic Nissen fundoplication and Rossetti's modification in 239 patients [Elektronische Daten] [P. L. Leggett, C.D. Bissell, R. Churchman-Winn, C. Ahn] Background: Laparoscopic Nissen fundoplication and the Rossetti modification represent two different surgical approaches to resolving gastroesophageal reflux disease (GERD). Concerns have arisen that the Rossetti modification results in increased postoperative dysphagia. In this study, we compared a group of patients who underwent a laparoscopic Nissen fundoplication with a group who had undergone the Rossetti modification to determine if there was a significant difference in postoperative dysphagia. Additionally, we wanted to confirm that the Nissen procedure performed laparoscopically could resolve GERD as successfully as the Rossetti modification, with no difference in operative complications. Methods: We prospectively collected data on 101 patients who underwent laparoscopic Nissen fundoplication and compared outcomes with those of 138 patients who had undergone the laparoscopic Rossetti modification in a previous series. Results: All patients experienced resolution of reflux symptoms. No statistically significant differences were found between the groups in terms of intraoperative or postoperative complications, conversions to open procedure, or length of hospitalization. Paradoxically, there was a significant difference in operating time between the Rossetti and the Nissen groups (70.6 min vs 45.6 min, p= 0.006). Postoperative dysphagia requiring dilation was significantly higher in the Rossetti group (21.7% vs 8.9%, p= 0.008). However, there was a significantly higher percentage of patients in the Rossetti group who had had esophagitis preoperatively (95.7% vs 86.1%, p= 0.009), although the proportion of patients having Barrett's esophagus was higher in the Nissen group (9.4% vs 24.8%, p= 0.001). Conclusions: Both approaches resolved reflux symptoms without significant differences in complications, conversions, or length of stay. Preoperative differences between groups, as well as the method of sequentially comparing the two different procedures, prevent us from attributing greater postoperative dysphagia in the Rossetti group solely to the choice of surgical approach. Prospective randomized studies are needed to control for variables, such as surgical team experience and patient differences. Springer-Verlag New York Inc., 2000 Key words: Fundoplication — Gastroesophageal reflux disease — Laparoscopy nationallicence Leggett P. L. Department of Surgery, Houston Northwest Medical Center, 800 Peakwood, Suite 8B, Houston, TX 77090, USA, US aut Bissell C.D. Department of Surgery, Houston Northwest Medical Center, 800 Peakwood, Suite 8B, Houston, TX 77090, USA, US aut Churchman-Winn R. Department of Surgery, Houston Northwest Medical Center, 800 Peakwood, Suite 8B, Houston, TX 77090, USA, US aut Ahn C. Section of Clinical Epidemiology, Department of Internal Medicine, University of Texas-Houston Medical School, Houston, TX 77030, USA, US aut Surgical Endoscopy Springer-Verlag 14/5(2000-05-01), 473-477 0930-2794 14:5<473 2000 14 464 https://doi.org/10.1007/s004640020079 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s004640020079 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Leggett P. L. Department of Surgery, Houston Northwest Medical Center, 800 Peakwood, Suite 8B, Houston, TX 77090, USA, US aut NATIONALLICENCE 700 1- Bissell C.D. Department of Surgery, Houston Northwest Medical Center, 800 Peakwood, Suite 8B, Houston, TX 77090, USA, US aut NATIONALLICENCE 700 1- Churchman-Winn R. Department of Surgery, Houston Northwest Medical Center, 800 Peakwood, Suite 8B, Houston, TX 77090, USA, US aut NATIONALLICENCE 700 1- Ahn C. Section of Clinical Epidemiology, Department of Internal Medicine, University of Texas-Houston Medical School, Houston, TX 77030, USA, US aut NATIONALLICENCE 773 0- Surgical Endoscopy Springer-Verlag 14/5(2000-05-01), 473-477 0930-2794 14:5<473 2000 14 464 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer