Laparoscopic mesh-augmented hiatoplasty as a method to treat gastroesophageal reflux without fundoplication: single-center experience with 306 consecutive patients

BACKGROUND: Laparoscopic fundoplication represents the Surgical standard treatment of gastroesophageal reflux disease. However, because of persisting side effects the method is not without controversy. Laparoscopic mesh-augmented hiatoplasty might be an alternative. METHODS: In 306 consecutive patients the perioperative course and symptomatic outcome was analyzed after a mean follow-up period of 52 months. RESULTS: The mean DeMeester symptom score decreased from 5.3 to 2.0 (P <.001). Acid-suppressive therapy on a regular basis was discontinued in 79% of patients. The gas bloating value decreased from .7 to .5 (P = .031), and the dysphagia value increased from .5 to .9 (P <.001). Belching and vomiting were possible in 93% and 88% of patients, respectively. Mesh-related complications with the need for reoperation occurred in 1% of patients. CONCLUSIONS: Laparoscopic mesh-augmented hiatoplasty is safe and does have an antireflux effect even without fundoplication. Side effects seem to be reasonable. (C) 2009 Elsevier Inc. All rights reserved.