OBJECTIVE To determine the relative benefits and risks of laparoscopic fundoplication surgery as an alternative to long term drug treatment for chronic gastro-oesophageal reflux disease (GORD). DESIGN Multicentre, pragmatic randomised trial (with parallel preference groups). SETTING 21 hospitals in the United Kingdom. PARTICIPANTS 357 randomised participants (178 surgical, 179 medical) an...

BACKGROUND There is controversy about the effectiveness of intraperitoneal local anaesthesia (LA) in laparoscopic surgery. The aim of the present randomized clinical trial was to compare the analgesic effect of pre-emptive (preoperative) versus postoperative intraperitoneal LA in two different types of laparoscopic surgery. METHODS Between July 2004 and January 2005, 133 consecutive patients ...

OBJECTIVE Laparoscopic Nissen fundoplication is performed in neonates and children for significant gastroesophageal reflux. An aberrant left hepatic artery encountered during laparoscopic Nissen fundoplication makes dissection around the esophageal hiatus more difficult if the artery is not transected. Although some suggest division of the aberrant left hepatic artery, this is associated with r...

BACKGROUND If a patient develops foregut symptoms after a fundoplication, it is assumed that the operation has failed, and acid-reducing medications are often prescribed. Esophageal function tests (manometry and pH monitoring) are seldom performed early in the management of these patients. HYPOTHESIS In patients who are symptomatic after fundoplication for gastroesophageal reflux disease, a s...

BACKGROUND In the treatment of achalasia, surgery has been traditionally reserved for patients with residual dysphagia after pneumatic dilatation. The results of laparoscopic Heller myotomy have proven to be so good, however, that most experts now consider surgery the primary treatment. HYPOTHESIS The outcome of laparoscopic myotomy and fundoplication for achalasia is dictated by technical fa...

BACKGROUND The need for a fundoplication during repair of paraesophageal hiatal hernias (PEH) remains unclear. Prevention of gastroesophageal reflux represents a trade-off against the risk of fundoplication-related side effects. The aim of this trial was to compare laparoscopic mesh-augmented hiatoplasty with simple cardiophrenicopexy (LMAH-C) with laparoscopic mesh-augmented hiatoplasty with f...

Introduction: More fundoplications are done because laparoscopic Nissen fundoplication is less invasive than open surgery. Although recovery after laparoscopic Nissen fundoplication is faster, and complications are fewer, than after open procedures, some potentially life-threatening complications can arise. Acute gastric volvulus is one of these and, because it is not a frequent event, its diag...

During the 1970s and the 1980s, operations for benign esophageal disorders were often withheld or delayed in favor of less effective forms of treatment in an effort to prevent the postoperative discomfort, the long hospital stay, and the recovery time associated with open surgical procedures. For instance, pneumatic dilatation became first-line therapy for achalasia, even though surgical manage...

Objective: given the demonstrated effectiveness of medical treatment together with the eminent acceptance of the laparoscopic approach, the indications of surgery in the treatment of gastroesophageal reflux disease (GERD) are currently subject to continuous controversy. To participate in this debate, we have the following work hypothesis: “The results of the 360o short and floppy laparoscopic f...

OBJECTIVES Approximately 80% of patients complain of various symptoms immediately after laparoscopic Nissen fundoplication. These symptoms typically are treated medically without an extensive evaluation to identify the cause. We reviewed our experience of laparoscopic Nissen fundoplication to determine the course of postoperative symptomatology in our patient population, and present a rational ...