Laparoscopic treatment of gastroesophageal reflux. Cardiopexia with the round ligament versus Nissen's type fundoplication

Thirty nine patients with a symptomatic gastrooesophageal reflux (RGO), resistant to or relapsing after medical treatment, were prospectively studied and operated on with a laparoscopic approach: 8 which a ligamentum teres cardiopexy, 31 with a 360 degrees fundoplicature. Both groups were comparable concerning clinical, endoscopic, mano- and pHmetric features (Anova test at 95% for all comparison in the study). There was no operative mortality. Conversion and morbidity rate were significantly higher (p = 0.04) in the "cardiopexy" group, even if data suggest a responsibility of the learning curve only. During follow-up patients were interviewed at 1, 3 and 12 months and proposed for mano- and pHmetry at 3 and 12 months. Late results at 12 months showed a relapse of RGO in 5 out of 8 patients of the "cardiopexy" group, with no relapse in "fundoplicature" group (p = 0.01). Mano- and pHmetric records showed at 3 months a persistent hypotony of the lower oesophageal sphincter and a persistent acid reflux in the "cardiopexy" group, with a significant (p = 0.01 and = 0.03) difference with "fundoplicature" group, in which lower oesophageal sphincter was hypercorrected and no reflux appeared at pHmetry. Despite some rare evidence in literature, cardiopexy do not give good late results, and laparoscopic 360 degrees fundoplicature seems to be the better procedure for surgical treatment of symptomatic RGO.