Mt. Viljakka et al., COMPLICATIONS OF OPEN AND LAPAROSCOPIC ANTIREFLUX SURGERY - 32-YEAR AUDIT AT A TEACHING HOSPITAL, Journal of the American College of Surgeons, 185(5), 1997, pp. 446-450
Background: Open or laparoscopic surgery for gastro-esophageal reflux
disease gives longterm freedom from symptoms in 83-100% of cases but h
as a certain percentage of complications. This study was undertaken to
evaluate the early and late complication rates after primary or repea
t antireflux operations. Study Design: The records of all patients who
underwent surgery for gastroesophageal reflux disease during a 32-yea
r period at a university teaching hospital were reviewed retrospective
ly. Records for 793 adults (448 men and 345 women) aged 16-85 years (m
ean, 51) were retrieved for calculation of complication rates and stat
istical analysis. Results: A total of 827 operations were performed: 7
93 primary and 41 for recurrent disease (2 patients were each reoperat
ed on twice). There were 49 laparoscopic operations. Only two patients
died (mortality, 0.3%), both after open operation. Morbidity was 24%
after open surgery and 14% after laparoscopic operation. The total (ea
rly and late) complication rate was higher after reoperations than tha
t after open or laparoscopic procedures. The overall complication rate
in the open operations was similar in the first and the third decade
of the study, namely, 24.6% and 26.1%, respectively. Conclusions: Surg
ical treatment of gastroesophageal reflux disease carries very low mor
tality when performed in a specialized unit. The main causes of morbid
ity after open operation are infectious complications. The incidence o
f complications is substantially lower after laparoscopic surgery than
after open operation. Reoperation is seldom required, but it carries
higher morbidity than the primary operations. (C) 1997 by the American
College of Surgeons).