LAPAROSCOPIC NISSEN FUNDOPLICATION AT A TEACHING CENTER - PROSPECTIVEANALYSIS OF 103 CONSECUTIVE PATIENTS

The Nissen fundoplication is the most extensively studied and successf ully employed surgical solution to gastroesophageal reflux disease (GE RD). Early success with the application of minimally invasive techniqu es to this procedure has been reported by several authors. One hundred three consecutive patients were operated on for the symptoms and comp lications of GERD. Preoperative evaluation consisted of esophagogastro duodenoscopy and esophageal manometry. Twenty-four-hour esophageal pH was obtained selectively. All cases were performed in a traditional tr aining environment, adhering to techniques previously described in the open literature. Clinical data consisted of operative time, postopera tive hospital days, days to resumption of normal activities, and morbi dity. Patients were followed clinically for the incidence of dysphagia , bloating, and recurrent reflux symptoms. These were graded using a m odified Visick score prior to discharge, at 1, 3, and 6 months, and th en annually. All patients underwent completion of their procedure; how ever, four required conversion to open technique and were excluded fro m analysis. Mean operative time for the 99 laparoscopic procedures was 180 min. Mean operative time was significantly longer for the first 5 0 cases (202.1 min) than the last 49 (164.2 min). Mean postoperative h ospital stay was 2.3 days with 10 days to resumption of normal activit ies. Mean follow-up was 15 months (range 3-39 months). Three of the fo ur treatment failures underwent open revision with good subsequent res ults. Patient satisfaction as reflected by the modified Visick score r eveals 96% good to excellent results (Visick 1 or 2) with no persisten t dysphagia. The Nissen fundoplication can be safely performed using m inimally invasive techniques with the benefit of postoperative recover y typical of other laparoscopic procedures. By strictly adhering to th e primary technical principles previously described in the open approa ch, early results are comparable. The procedure can be safely performe d in a traditional training environment. The modified Visick system is a simple and effective method to quantify postoperative patient satis faction.