A Case of Usefulness of Laparoscopic Surgery for Reflux Esophagitis with Esophageal Stenosis

Nobue Futawatari, Natsuya Katada, Hiromitsu Moriya, Keishi Yamashita, Shinichi Sakuramoto, Shiro Kikuchi and Masahiko Watanabe

Depertment of Surgery, School of Medicine, Kitasato University

We report a case of laparoscopic surgery for reflux esophagitis with severe esophageal stenosis. A 64-year old man admitted for heartburn, dysphasia, and vomiting was found in upper gastrointestinal endoscopy to have reflux esophagitis with Los Angeles Classification Grade D and pin-hole stenosis of the lower esophagus. Initially administered proton pump inhibitor did not ameliorate, symptoms, so we conducted seven sessions of endoscopic balloon dilation, without favorable effect and with early return of the stenosis. Fraction time pH<4 was 6.8% in 24-hour pH monitoring, and the manometry showed a low esophageal body amplitude. Based on a diagnosis of reflux esophagitis with severe esophageal stenosis, we conducted laparoscopic Toupet fundoplication. Dysphasia disappeared postoperatively, as did the mucosal break and esophageal stenosis as evidenced in gastrointestinal endoscopy. In 24-hour pH monitoring, fraction time pH<4 was normalized to 0.3%.

Key words
reflux esophagitis, esophagial stenosis, laparoscopic surgery

Reprint requests
Nobue Futawatari Department of Surgery, School of Medicine, Kitasato University
2-1-1 Asamizodai, Sagamihara, 228-8520 JAPAN

Accepted
May 21, 2008

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