This study was designed to evaluate the outcome of combined laparoscopic
cholecystectorruy and fundoplication during one single laparoscopic
procedure. The study included only patients assigned to undergo cholecystectorruy
for calcuku- cholecystitis and had symptomatic gastroesophagent
reflux disease (GERD), 22 patients (7 males 8r. 15 fernnies) 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 recordecL
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 of choledocholithiasis not resolved
endoscopically, suspicion of gallbladder
carcinoma, associated
condition requiring open surgery,
bilharzial hepato-spleenomegally,
non-treatable coagulation disturbances
and age over 70 years. |
