Complicações do tratamento laparoscópico da doença do refluxo gastroesofágico: experiência com 600 casos

Coelho, Júlio Cezar U.; Wiederkehr, Júlio Cesar; Campos, Antonio Carlos L.; Andrigueto, Paulo Cesar; Pinho, Renato Valmassoni; Bonin, Eduardo Aimoré

doi:10.1590/S0100-69911999000400008

Resumos

O objetivo do presente estudo é apresentar as complicações que ocorreram em seiscentos pacientes consecutivos com doença do refluxo gastroesofágico submetidos à fundoplicatura laparoscópica. O procedimento de Nissen-Rosetti (fundoplicatura de 360°) foi realizado em 587 pacientes (97,8%) e o de Toupet (fundoplicatura de 270°) em 13 (2,2%). Oitenta e um pacientes também foram submetidos à colecistectomia no mesmo ato operatório, e um a diverticulectomia faringoesofágica cervical com miotomia cricofaringeana. Trinta e nove pacientes tinham operação prévia no abdome superior. O período de internação hospitalar variou de 12 horas a 23 dias, com média de 1,2 dias. A via de acesso foi convertida em laparotomia em dez pacientes (1,7%). A principal causa de conversão foi a presença de aderências. A complicação intra- operatória mais freqüente foi pneumotórax, que foi observado em oito pacientes. Todos os pneumotóraces ocorreram nos cem primeiros casos. Cinco pacientes apresentaram hemorragia significante, sendo que dois deles necessitaram laparotomia para controle do sangramento. Úlcera gástrica foi diagnosticada em sete pacientes. Um paciente etilista morreu de pancreatite aguda e outro de síndrome de disfunção de múltiplos órgãos e sistemas conseqüente à perfuração gástrica. Outras complicações importantes foram: dois abscessos intra-abdominais, uma perfuração esofágica, uma sepse secundária à perfuração gástrica, um choque hemorrágico e uma obstrução gástrica secundária à herniação da fundoplicatura. Concluímos que a taxa de complicações da fundoplicatura laparoscópica é baixa e diminui significativamente com a experiência do cirurgião.

Fundoplicatura; Operação anti-refluxo; Laparoscopia; Refluxo gastroesofágico; Esofagite de refluxo; Perfuração gástrica

The objective of the present study is to present the complications that occurred in 600 consecutive patients with gastroesophageal reflux disease who underwent laparoscopic fundoplication. A Nissen-Rosetti procedure (360° fundoplication) was performed in 587 patients (97.8%) and a Toupet procedure (270(0) fundoplication) in 13 (2.2%). Eighty- one patients were also subjected to a concurrent cholecystectomy and one patient a concurrent cervical pharyngoesophageal diverticulectomy with cricopharyngeal myotomy. Thirty-nine patients had a previous upper abdominal operation. The period of hospitalization varied from 12 hours to 23 days, with an average of 1.2 days. The operation was converted to an open procedure in 10 patients (1,7%). The main cause of conversion was the presence of adhesions. The most frequent intraoperative complication was pneumothorax, that was observed in eight patients. All pneumothoraces occurred in the first 100 cases. Five patients had significant operative bleeding; two of them required laparotomy for bleeding control. Gastric ulcer was diagnosed in seven patients. One alcoholic patient died of acute pancreatitis and other with gastric perforation of multiple organ failure syndrome. Other major complications were two intrabdominal abscesses, one esophageal perforation, one sepsis due to gastric perforation, one hemorrhagic shock, and one gastric obstruction due to fundoplication herniation. It is concluded that complications of laparoscopic fundoplication are low and decrease significantly with the surgeon's experience.

Fundoplication; Antireflux operation; Laparoscopy; Gastroesophageal reflux; Reflux esophagitis; Gastric perforation

ARTIGOS ORIGINAIS

Complicações do tratamento laparoscópico da doença do refluxo gastroesofágico. Experiência com 600 casos

Complications of laparoscopic treatment of the gastroesophageal reflux disease. Experience with 600 cases

Júlio Cezar U. Coelho, TCBC-PR^I; Júlio Cesar Wiederkehr, TCBC-PR^I; Antonio Carlos L. Campos, TCBC-PR^I; Paulo Cesar Andrigueto, ACBC-PR^I; Renato Valmassoni Pinho, TCBC-PR^I; Eduardo Aimoré Bonin^II

^ICirurgião do Hospital Nossa Senhora das Graças - Curitiba

^IIMédico Residente do Hospital Nossa Senhora das Graças - Curitiba

^{Endereço para correspondência} Endereço para correspondência: Dr. Júlio Cezar U. Coelho Rua Bento Viana, 1140 - Ap. 2202 80240-110 - Curitiba-PR Fone/Fax: (041) 322-3789 e 322-0214

RESUMO

O objetivo do presente estudo é apresentar as complicações que ocorreram em seiscentos pacientes consecutivos com doença do refluxo gastroesofágico submetidos à fundoplicatura laparoscópica. O procedimento de Nissen-Rosetti (fundoplicatura de 360°) foi realizado em 587 pacientes (97,8%) e o de Toupet (fundoplicatura de 270°) em 13 (2,2%). Oitenta e um pacientes também foram submetidos à colecistectomia no mesmo ato operatório, e um a diverticulectomia faringoesofágica cervical com miotomia cricofaringeana. Trinta e nove pacientes tinham operação prévia no abdome superior. O período de internação hospitalar variou de 12 horas a 23 dias, com média de 1,2 dias. A via de acesso foi convertida em laparotomia em dez pacientes (1,7%). A principal causa de conversão foi a presença de aderências. A complicação intra- operatória mais freqüente foi pneumotórax, que foi observado em oito pacientes. Todos os pneumotóraces ocorreram nos cem primeiros casos. Cinco pacientes apresentaram hemorragia significante, sendo que dois deles necessitaram laparotomia para controle do sangramento. Úlcera gástrica foi diagnosticada em sete pacientes. Um paciente etilista morreu de pancreatite aguda e outro de síndrome de disfunção de múltiplos órgãos e sistemas conseqüente à perfuração gástrica. Outras complicações importantes foram: dois abscessos intra-abdominais, uma perfuração esofágica, uma sepse secundária à perfuração gástrica, um choque hemorrágico e uma obstrução gástrica secundária à herniação da fundoplicatura. Concluímos que a taxa de complicações da fundoplicatura laparoscópica é baixa e diminui significativamente com a experiência do cirurgião.

Unitermos: Fundoplicatura; Operação anti-refluxo; Laparoscopia; Refluxo gastroesofágico; Esofagite de refluxo; Perfuração gástrica.

ABSTRACT

The objective of the present study is to present the complications that occurred in 600 consecutive patients with gastroesophageal reflux disease who underwent laparoscopic fundoplication. A Nissen-Rosetti procedure (360° fundoplication) was performed in 587 patients (97.8%) and a Toupet procedure (270⁰ fundoplication) in 13 (2.2%). Eighty- one patients were also subjected to a concurrent cholecystectomy and one patient a concurrent cervical pharyngoesophageal diverticulectomy with cricopharyngeal myotomy. Thirty-nine patients had a previous upper abdominal operation. The period of hospitalization varied from 12 hours to 23 days, with an average of 1.2 days. The operation was converted to an open procedure in 10 patients (1,7%). The main cause of conversion was the presence of adhesions. The most frequent intraoperative complication was pneumothorax, that was observed in eight patients. All pneumothoraces occurred in the first 100 cases. Five patients had significant operative bleeding; two of them required laparotomy for bleeding control. Gastric ulcer was diagnosed in seven patients. One alcoholic patient died of acute pancreatitis and other with gastric perforation of multiple organ failure syndrome. Other major complications were two intrabdominal abscesses, one esophageal perforation, one sepsis due to gastric perforation, one hemorrhagic shock, and one gastric obstruction due to fundoplication herniation. It is concluded that complications of laparoscopic fundoplication are low and decrease significantly with the surgeon's experience.

Key words: Fundoplication; Antireflux operation; Laparoscopy; Gastroesophageal reflux; Reflux esophagitis; Gastric perforation.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

2. Spechler SJ. Epidemiology and natural history of gastroesophageal reflux disease. Digestion 1992, Suppl.l, 51:24-29.

Recebido em 7/5/99

Aceito para publicação em 15/7/99

Trabalho realizado no Serviço de Cirurgia Geral do Hospital Nossa Senhora das Graças - Curitiba - PR.

1. Stein HJ, Barlow AP, DeMeester TR, Hinder RA. Complications of gastroesophageal reflux disease. Role of the lower esophageal sphincter, esophageal acid and acid/alkaline exposure, and duodenogastric reflux. Ann Surg 1992; 216:35-43.
3. Horgan S, Pellegrini CA. Surgical treatment of gastroesophageal reflux disease. Surg Clin N Am 1997;77: 1063-1082.
4. Peters JH, Heimbucher J, Kauer WKH, et al. Clinical and physiologic comparison of laparoscopic and open Nissen fundoplication. J Am Coll Surg 1995;180:385-393.
5. Geagea T. Laparoscopic Nissen's fundoplication: preliminary report on ten cases. Surg Endosc 1991;5:170-172
6. Dallemagne B, Weerts JM, Jehaes C, et al. Laparoscopic Nissen fundoplication: preliminary report. Surg Laparosc Endosc 1991; 1:138-139.
7. Cattey RP, Henry LG, Bielefield MR. Laparoscopic Nissen fundoplication for gastroesophageal reflux disease: clinical experience and outcome in first 100 patients. Surg Laparosc Endosc 1996; 6:430-433.
8. Nano M, Redivo L, Fonte G, et al. One year follow-up results in the surgical treatment of gastroesophageal reflux disease. Int Surg 1996; 81:27-31.
9. Zaninotto G, Anselmino M, Costantini M, et al. Laparoscopic treatment of gastro-esophageal reflux disease: indications and results. Int Surg 1995;80:380-385.
10. Hunter JG, Trus TL, Branum GD, et al. A physiologic approach to laparoscopic fundoplication for gastroesophageal reflux disease. Ann Surg 1996;6:673-687.
11. Wasvary H, Wease G, Bierema T, Glover J. Gastro-aortic fistula: an uncommon complication of Nissen fundoplication. Am Surg 1997; 63:455-458.
12. Fontaumard E, Espalieu P, Boulez J. Résultats de la cure coelioscopique du reflux gastro-oesophagien selon Nissen-Rossetti. A propos de 94 cas. Ann Chir 1995;49:507-512.
13. Schauer PR, Meyers WC, Eubanks S, et al. Mechanisms of gastric and esophageal perforations during laparoscopic Nissen fundoplication. Ann Surg 1996; 223:43-52.
14. Collet D, Cadięre GB. Conversions and complications of laparoscopic treatment of gastroesophageal reflux disease. Am J Surg 1995; 169: 622-626.
15. Urschel JD Complications of antireflux surgery. Am J Surg 1993; 165: 68-70.
16. Pinotti HW, Domene CE, Nasi A. Tratamento cirúrgico da esofagite de refluxo por videolaparoscopia. In Pinotti HW (ed)- Tratado de clínica cirúrgica do aparelho digestivo. São Paulo: Editora Atheneu, 1994, pp 386-388.
17. Marchesini JB, Malafaia O. Doença do refluxo gastroesofágico. São Paulo: Editora Atheneu, 1996.
18. DePaula AL, Hashiba K, Bafutto M, et al. Laparoscopic reoperations after failed and complicated antireflux operations. Surg Endosc 1995; 9:681-686.
19. McKernan JB, Champion JK. Laparoscopic antireflux surgery. Am Surg 1995;61:530-536.
20. Luostarinen M. Nissen fundoplication for reflux esophagitis. Long- term clinical and endoscopic results in 109 of 127 consecutive patients. Ann Surg 1993; 217:329-337.
21. Watson DI, Pike GK, Baigrie RJ, et al. Prospective double-blind randomized trial of laparoscopic Nissen fundoplication with division and without division of short gastric vessels. Ann Surg 1997;5: 642-52.
22. Coelho JCU, Marchesini JB, Malafaia O. Complicações da videocirurgia. Da profilaxia ao tratamento. Rio de Janeiro: Editora Medsi, 1995.
23. Coelho JCU, De Araujo RPM, Marchesini JB et al. Pulmonary function after cholecystectomy performed through Kocher's incision, a mini-incision, and laparoscopy. World J Surg 1993;17:544-546.
24. Campbell R, Kennedy T, Johnston GW. Gastric ulceration after Nissen fundoplication. Br J Surg 1983;70:406-407.
25. Low DE, Mercer CD, James EC, Rill LD. Post Nissen syndrome. Surg Gynecol Obstet 1988;167:1-5.
26. Trus T L, Laycock WS, Branum G, et al. Intermediate follow-up of laparoscopic antireflux surgery. Am J Surg 1996;171 :32-35.
27. Brandalise NA, Montes CG, Aranha NC, et al. Úlcera gástrica após a fundoplicatura de Nissen. GED 1997; 16:144-146.

Endereço para correspondência:

Dr. Júlio Cezar U. Coelho

Rua Bento Viana, 1140 - Ap. 2202

80240-110 - Curitiba-PR

Fone/Fax: (041) 322-3789 e 322-0214

Datas de Publicação

Publicação nesta coleção
27 Jan 2010
Data do Fascículo
Ago 1999

Histórico

Aceito
15 Jul 1999
Recebido
07 Maio 1999

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Stein HJ, Barlow AP, DeMeester TR, Hinder RA. Complications of gastroesophageal reflux disease. Role of the lower esophageal sphincter, esophageal acid and acid/alkaline exposure, and duodenogastric reflux. Ann Surg 1992; 216:35-43.

[2] 3. Horgan S, Pellegrini CA. Surgical treatment of gastroesophageal reflux disease. Surg Clin N Am 1997;77: 1063-1082.

[3] 4. Peters JH, Heimbucher J, Kauer WKH, et al. Clinical and physiologic comparison of laparoscopic and open Nissen fundoplication. J Am Coll Surg 1995;180:385-393.

[4] 5. Geagea T. Laparoscopic Nissen's fundoplication: preliminary report on ten cases. Surg Endosc 1991;5:170-172

[5] 6. Dallemagne B, Weerts JM, Jehaes C, et al. Laparoscopic Nissen fundoplication: preliminary report. Surg Laparosc Endosc 1991; 1:138-139.

[6] 7. Cattey RP, Henry LG, Bielefield MR. Laparoscopic Nissen fundoplication for gastroesophageal reflux disease: clinical experience and outcome in first 100 patients. Surg Laparosc Endosc 1996; 6:430-433.

[7] 8. Nano M, Redivo L, Fonte G, et al. One year follow-up results in the surgical treatment of gastroesophageal reflux disease. Int Surg 1996; 81:27-31.

[8] 9. Zaninotto G, Anselmino M, Costantini M, et al. Laparoscopic treatment of gastro-esophageal reflux disease: indications and results. Int Surg 1995;80:380-385.

[9] 10. Hunter JG, Trus TL, Branum GD, et al. A physiologic approach to laparoscopic fundoplication for gastroesophageal reflux disease. Ann Surg 1996;6:673-687.

[10] 11. Wasvary H, Wease G, Bierema T, Glover J. Gastro-aortic fistula: an uncommon complication of Nissen fundoplication. Am Surg 1997; 63:455-458.

[11] 12. Fontaumard E, Espalieu P, Boulez J. Résultats de la cure coelioscopique du reflux gastro-oesophagien selon Nissen-Rossetti. A propos de 94 cas. Ann Chir 1995;49:507-512.

[12] 13. Schauer PR, Meyers WC, Eubanks S, et al. Mechanisms of gastric and esophageal perforations during laparoscopic Nissen fundoplication. Ann Surg 1996; 223:43-52.

[13] 14. Collet D, Cadięre GB. Conversions and complications of laparoscopic treatment of gastroesophageal reflux disease. Am J Surg 1995; 169: 622-626.

[14] 15. Urschel JD Complications of antireflux surgery. Am J Surg 1993; 165: 68-70.

[15] 16. Pinotti HW, Domene CE, Nasi A. Tratamento cirúrgico da esofagite de refluxo por videolaparoscopia. In Pinotti HW (ed)- Tratado de clínica cirúrgica do aparelho digestivo. São Paulo: Editora Atheneu, 1994, pp 386-388.

[16] 17. Marchesini JB, Malafaia O. Doença do refluxo gastroesofágico. São Paulo: Editora Atheneu, 1996.

[17] 18. DePaula AL, Hashiba K, Bafutto M, et al. Laparoscopic reoperations after failed and complicated antireflux operations. Surg Endosc 1995; 9:681-686.

[18] 19. McKernan JB, Champion JK. Laparoscopic antireflux surgery. Am Surg 1995;61:530-536.

[19] 20. Luostarinen M. Nissen fundoplication for reflux esophagitis. Long- term clinical and endoscopic results in 109 of 127 consecutive patients. Ann Surg 1993; 217:329-337.

[20] 21. Watson DI, Pike GK, Baigrie RJ, et al. Prospective double-blind randomized trial of laparoscopic Nissen fundoplication with division and without division of short gastric vessels. Ann Surg 1997;5: 642-52.

[21] 22. Coelho JCU, Marchesini JB, Malafaia O. Complicações da videocirurgia. Da profilaxia ao tratamento. Rio de Janeiro: Editora Medsi, 1995.

[22] 23. Coelho JCU, De Araujo RPM, Marchesini JB et al. Pulmonary function after cholecystectomy performed through Kocher's incision, a mini-incision, and laparoscopy. World J Surg 1993;17:544-546.

[23] 24. Campbell R, Kennedy T, Johnston GW. Gastric ulceration after Nissen fundoplication. Br J Surg 1983;70:406-407.

[24] 25. Low DE, Mercer CD, James EC, Rill LD. Post Nissen syndrome. Surg Gynecol Obstet 1988;167:1-5.

[25] 26. Trus T L, Laycock WS, Branum G, et al. Intermediate follow-up of laparoscopic antireflux surgery. Am J Surg 1996;171 :32-35.

[26] 27. Brandalise NA, Montes CG, Aranha NC, et al. Úlcera gástrica após a fundoplicatura de Nissen. GED 1997; 16:144-146.

Brasil

Brasil

Complicações do tratamento laparoscópico da doença do refluxo gastroesofágico: experiência com 600 casos

Complications of laparoscopic treatment of the gastroesophageal reflux disease: experience with 600 cases

Resumos

Datas de Publicação

Histórico