Is the use of a bougie necessary for laparoscopic Nissen fundoplication?

Archives of Surgery
Yuri W NovitskyDemetrius E M Litwin

Abstract

Esophageal intubation with a bougie during laparoscopic Nissen fundoplication (LNF) is commonly used to prevent an excessively tight wrap. However, a bougie may cause intraoperative gastric and esophageal perforations. We hypothesized that LNF is safe and effective when performed without a bougie. Retrospective review of 102 consecutive patients who underwent LNF without a bougie. Tertiary care university hospital. All patients presented with symptoms of reflux disease. Mean (+/- SD) percentage of time with pH of less than 4 was 12.6% +/- 9.4%. Mean DeMeester score was 47.8. Mean (+/- SD) resting lower esophageal sphincter pressure was 15.0 +/- 9.4 mm Hg. Mean (+/- SD) distal esophageal amplitude was 69.4 +/- 39.2 mm Hg. During LNF, we obtained 2 to 3 cm of intra-abdominal esophagus, divided all short gastric vessels, reapproximated the crura, and performed a loose 360 degrees fundoplication without a bougie. Postoperative rates of dysphagia, gas bloat, and recurrent reflux. In the early postoperative period, 50 patients (49.0%) complained of mild, 11 (10.8%) of moderate, and 7 (6.9%) of severe dysphagia. Average (+/- SD) duration of early dysphagia was 4.6 +/- 2.1 weeks. Dysphagia resolved in 61 (89.7%) of 68 patients within 6...Continue Reading

Citations

Apr 13, 2004·Annals of Surgery·Marco CatarciGiovanni Battista Grassi
Nov 1, 2008·Journal of Laparoendoscopic & Advanced Surgical Techniques. Part a·Viney K MathavanJeffrey M Marks
Oct 7, 2006·Surgical Endoscopy·D ZacharoulisC M S Royston
Jun 25, 2009·Surgical Endoscopy·Krishnamurthy SomasekarAhmed Hassn
Nov 17, 2007·American Journal of Surgery·Victor BochkarevDmitry Oleynikov
May 10, 2006·ANZ Journal of Surgery·Jeremyd Hayden, Glyng Jamieson
Jan 1, 2014·Surgical Innovation·Silvana PerrettaBernard Dallemagne
Sep 18, 2007·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Narayanasamy RaviJohn V Reynolds

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