LAPAROSCOPIC FUNDOPLICATION - A NATURAL EXTENSION FOR THE THORACIC SURGEON

Background. Thoracic surgeons have historically played a significant r ole in surgical treatment of benign esophageal disorders. With the adv ent of video-assisted thoracic surgical techniques, chest surgeons hav e also become adept at minimally invasive procedures. Thus, it seems a ppropriate that thoracic surgeons participate in minimally invasive an tireflux operations, such as laparoscopic Nissen fundoplication. Metho ds. From February 1993 to May 1995, 66 patients (32 male, 34 female) w ith a mean age of 45.5 years (range, 15 to 82 years) underwent a lapar oscopic fundoplication, Gastroesophageal reflux disease was diagnosed on the basis of history and endoscopically documented esophagitis or a bnormal esophageal pH testing or both. There were 45 type I, 3 type II , and 7 type III hiatal hernias. Eleven patients had gastroesophageal reflux disease with no hernia. Results. Conversion to laparotomy occur red in 6 patients (9%) due to bleeding in 2 patients, inability to exp ose the gastroesophageal junction in 3, and gastric laceration in 1 pa tient. All but 1 patient underwent a Nissen fundoplication performed o ver a 50F to 60F dilator. The remaining patient (type II hernia withou t gastroesophageal reflux disease) underwent a reduction, closure, and anterior gastropexy. There was no operative mortality. Immediate post operative morbidity included moderate dysphagia in 7 patients (11%), i leus in 2 patients (3%), and deep venous thrombosis and atrial arrhyth mia in 1 each (1.5%). Excluding 1 patient hospitalized for 42 days due to severe psychosis, the mean postoperative stay was 4.0 +/- 2.5 days (median, 3 days). Three patients (5%) required dilation for dysphagia , and 1 (1.5%) has noted recurrent reflux during follow-up (mean, 14.4 months; range, 6 to 30 months). A single patient has undergone reoper ation for persistent dysphagia (1.5%). Conclusions. A laparoscopic Nis sen procedure is safe, effective treatment for refractory gastroesopha geal reflux disease when performed by thoracic surgeons experienced in minimally invasive surgical procedures.