A fundoplicatura total por laparoscopia na doença do refluxo gastresofágico

Guedes da Silva¹, S. Fonseca², J. Penedo³, A. Formiga⁴, R. Rio Tinto⁵, M. J. Lopes⁶

 

Resumo

Em 8 anos, 62 doentes com refluxo gastresofágico sintomático, com ou sem hérnia do hiato, foram submetidos a fundoplicatura total por laparoscopia, sem mortalidade operatória, por uma equipa do Serviço 6 do Hospital Santo António dos Capuchos em Lisboa. Cinquenta e cinco doentes (89%) foram integralmente tratados por laparoscopia. Os restantes 7 doentes (11%) foram excluídos desta análise, por a fundoplicatura ter sido concluída após conversão em laparotomia. A selecção para terapêutica cirúrgica decorreu da integração dos dados da anamnese com os resultados da endoscopia digestiva alta, da pHmetria de 24 horas e da manometria esofágicas. Com pontuais diferenças, foi adoptada uma técnica cirúrgica uniforme na realização da fundoplicatura total. O tipo médio de internamento pós-cirúrgico foi de 4,2 dias. O seguimento clínico em consulta externa abrangeu 50 doentes. Com um recuo médio de 17,6 meses, 98% dos operados estavam assintomáticos. Em quinze voluntários foram realizados exames complientares aos seis meses de pós-operatório para monitorização da fundoplicatura. Neste subgrupo de controlo, em compliento da análise gráfica relativa aos índices de Dieester e às pressões do esfíncter esofágico inferior, antes e após fundoplicatura total, foi estatisticamente confirmada a eficácia do método cirúrgico por aplicação do teste de Wilcoxon (p=0,0001).

 

Summary

Sixty-two patients with GERD, with or without hiatal hernia, underwent total laparoscopic Nissen fundoplication (between Septiber 1995 and October 2003) on our surgery service (Serviço 6, Hospital Santo António dos Capuchos, Lisboa, Portugal) with no subsequent mortality. Of these, 55 patients (89%) were treated by laparoscopy alone. The riaining 7 patients (11%) were excluded from this analysis due to conversion to laparotomy. Selection for surgical treatment was based on the patient's history and upper endoscopy, 24-hour intra-oesophageal pH and manometry results. A uniform operative technique was used for the fundoplication, with only slight differences relating to progression or differences in circumstances. Average post-operative stay was 4.2 days. Outpatient follow-up included 50 patients. After an average follow-up of 17.6 months, 98% of patients were asymptomatic. Additional post-operative tests were carried out in fifteen volunteers to evaluate the efficacy of fundoplication in the control of GERD and hiatal hernia. Application of the Wilcoxon's test (p=0.0001) supported the efficacy of the method.

 

 

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(1) Assistente Hospitalar Graduado de Cirurgia Geral.

(2) Assistente Hospitalar de Cirurgia Geral.

(3) Assistente Hospitalar de Cirurgia Geral.

(4) Assistente Hospitalar Graduado de Cirurgia Geral.

(5) Assistente Hospitalar de Gastrenterologia.

(6) Assistente Hospitalar Graduado de Gastrenterologia.

Hospital de Santo António dos Capuchos, Lisboa, Portugal.

 

Recebido para publicação 31/03/2005

Aceite para publicação 27/01/2006