Laparoscopic Nissen-Rossetti fundoplication is effective to control gastroesophageal and pharyngeal reflux detected using 24-hour esophageal impedance and pH monitoring

The study aims to evaluate, at medium- and long-term follow-up, the efficacy of Nissen-Rossetti fundoplication to control both gastro-oesophageal and pharyngeal reflux, detected with the use of 24-hour pH-multi-channel intra-luminal impedance. Of the 1000 patients who underwent Nissen-Rossetti fundoplication in our Division since 1972, the laparoscopic approach was adopted in 428 consecutive patients with gastro-oesophageal reflux disease. The study population consisted of patients from this group with one-year follow-up. Thirty-one patients had undergone pre-operative evaluation with pH-multi-channel intra-luminal impedance and were classified on the basis of clinical assessment into gastro-oesophageal, or pharyngeal reflux disease group. Pre-operative data are reported. Comparison between gastro-oesophageal reflux and pharyngeal reflux are extrapolated from pH-multi-channel intra-luminal impedance. No conversion to open surgery and no mortality occurred. A major complication occurred in 4 patients (1.1%) and led to a re-intervention in 3. An excellent outcome was reported in 92.9% of the patients at mean follow-up of 83.2 +/- 7 months. Instrumental outcomes are discussed. In conclusion, Nissen-Rossetti fundoplication provides excellent protection from gastro-oesophgeal and pharyngeal reflux. The use of pH-multi-channel intra-luminal impedance is suitable in patients candidate to anti-reflux surgery to detect non-acid reflux.