COMPLICATIONS OF OPEN AND LAPAROSCOPIC ANTIREFLUX SURGERY - 32-YEAR AUDIT AT A TEACHING HOSPITAL

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).