Enfermedad por reflujo gastroesofágico

Abstract

At present the gastroesophageal reflux disease can be defined as a group of several symptoms, signs and lesions of the esophageal mucosa produced by gastric reflux material into the esophagus. The incompetence of the inferior esophageal sphincter causes the gastroesophageal reflux, therefore the gastric material produces the damage of the esophageal mucosa. Between 50 to 70% of the patients have endoscopic anomalies. The present therapeutic management of the gastroesophageal reflux disease (GRD) in patients with mild to moderate symptomatology is with a mini-invasive surgical procedure. The aim of this report was to present the authors' experience with the surgical management of the GRD. Population: we studied 104 patients with GRD treated surgically with laparoscopic approach. The mean-age was 51,7 years, and there were 58.6% of women and 41.4% of men. Of these patients, 85% presented a typical form of the disease (retrosternal pain and pyrosis). The technique employed was the Nissen procedure. Normally, a small amount of physiologic gastroesophageal reflux occurs during and after meals. GRD becomes important clinically when normal or increased amounts of reflux produce symptoms or result in complications such as esophagitis and tracheopulmonary aspiration. Symptomatic GRD is common, with 10% of the population suffering daily heartburn. Only a small portion of these subjects, however, seek medical care. An antireflux operation should be considered satisfactory when the patient has seen the symptoms that bothered him disappear and the lower esophageal sphincter has recovered its competency that opens and closes with each swallowing motion. Results: 104 patients with GRD were operated upon between May 1993 and May 2002. The mean hospitalization stay was between 12 hours and 16 days. A total of 97 patients become asymptomatic (93.2%); 6 conversions should be performed because of hemorrhages (5.7%). Postoperative complications were detected in 17 cases of dysphagia spontaneously resolved (16.3%) and one case required an open procedure. There was no mortality. Conclusions: the Nissen technique by laparoscopic approach is the treatment of first choice for the surgical treatment of GRD. The morbi-mortality is low, but it is very important a careful selection of the patients to obtain a successful outcome.