PubMed · 8063207
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M Hobsley. 1994. Training for digestive surgery.. https://doi.org/10.1136/gut.35.7.1007
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Although laparoscopy has been available since the turn of the century, the technique did not become widely accepted for gastrointestinal surgery until it was used in cholecystectomy. Since then, various gastrointestinal operations have been performed using laparoscopic guidance. Laparoscopic operations must conform to principles for open general surgery, especially in cases of oncologic resection. Procedures for treatment of conditions such as hiatal hernia, gastroesophageal reflux, intractable peptic ulcer disease, bypass for malignant pancreatic obstruction and repair of rectal prolapse have received immediate acceptance. Other procedures, such as Whipple's operation and colectomy for cancer, have met with a more guarded response.
Widespread us of laparoscopic surgery adds a new element to the debate over the choice between medical or surgical treatment for gastro-oesophageal reflux. Patients and gastroenterologists often favour medical management to avoid post-operative pain, a long recovery period, an abdominal scar or the risk of eventration but at the cost of long-term drug therapy and the need for repeated check-ups and endoscopy examinations. Yet surgery was found to give better long-term results in the only study comparing surgery and medical treatment. The question of cost and insurance coverage must also be considered. Although the indications for laparoscopic surgery would be identical to those for laparotomy it is probably possible that a wider population could benefit from this technique as laparoscopic cure can be indicated as an alternative in patients highly dependent on drug therapy. Relapse in patients with a long-term medical regimen is another recent indication. We should however always keep in mind that good outcome after laparoscopic surgery depends not only on a correct indication and evaluation of the oesophageal motricity but also on the skill and experience of the surgical team. Laparoscopic cure should certainly play a major role in the treatment of gastro-oesophageal reflux and will undoubtedly soon be the second most frequent laparoscopic technique performed after laparoscopic cholecystectomy.
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