This study was designed to evaluate the outcome of combined laparoscopic
cholecystectomy and fundoplication during one single laparoscopic
procedure. The study included only patients assigned to undergo cholecystectomy
for calcular cholecystitis and had symptomatic gastroesophageal
rejlux disease (GERD), 22 patients (7 males & 15 females) were enrolled
in the study. All patients underwent clinical history taking
including duration of symptoms, physical examination and upper gastrointestinal
endoscopy. Esophageal manometry was performed preoperatively
and 2 and 6 months after surgery. Laparoscopic procedures were
performed through 5-port access. Operative time and the frequency of
conversion to open surgery, time till initiation of oral intake, postoperative
hospital stay and complications and time to recover full activity were recorded.
Through a monthly visit for 6 months after surgery, patients were
monitored for the extent of resolution of GERD-related symptoms. There
was a significant increase (p<0.001) of postoperative lower esophageal
sphincter (LES) pressure compared to preoperative pressure with a nonsignificant
difference between pressures estimated at 2 and 6 months. No
intraoperative complications were encountered and there was no need for
conversion to open surgery in any case. The mean operative time was
78.3+9.7; range: 60-90 minutes. All patients tolerated oral ingestions after
the first 48 hours. The mean duration of postoperative hospital stay
was 4+0.8; range: 3-5 days and 9 patients (40.9%) were discharged on the 3rd postoperative day. The mean duration tilt resumption of full drill j
activities was 11.6+1.4 (10-14) days. Clinically, a marked resolution of
symptoms due to reflux' was observed, only one patient developed dysphagia
for solid food and a. sensation of trapped air occurred in two patients
causing discomfort, however, these three patients were asymptomatic
at 6 months after the surgery. It could be conclnr1Pd that combined
laparoscopic surgery for cholelithiasis and GERD is an appropriate procedure,
when indirated, giving excellent short-term outcome results and
could be managed during one single laparoscopic procedure. |
