LAPAROSCOPIC NISSEN FUNDOPLICATION - 200 CONSECUTIVE CASES

Patients-Laparoscopic Nissen fundoplication was undertaken in 200 pati ents between 1991 and 1994. Methods-Pre-operative assessment included symptom score, endoscopy, manometry, and 24 hour pH monitoring of the oesophagus. Patients were evaluated at three and 12 months after surge ry with symptom scoring and 96 patients also underwent 24 hour pH stud ies at three to six months postoperatively. Results-In the first 100 p atients median duration of operation was 155 minutes (range: 70-330), conversion rate to laparotomy was 7%, median hospital stay was three d ays (range: 2-57), and total morbidity was 16%. This compared with a m edian operation time of 120 minutes (60-240) (p=0.0003, 95% CI 10, 40) , a conversion rate of 2% (p=0.2), a hospital stay of three days (1-18 ) (p=0.0016, 95% CI 0, 1), and total morbidity of 7% (p=0.15) in the s econd 100 patients. Median total symptom scores fell from 5/9 to 0/9 a fter fundoplication (<0.0001) while median 24 hour oesophageal acid ex posure in 96 patients was reduced from 10% to 1% (p<0.001). Conclusion s-Laparoscopic Nissen fundoplication is a safe and effective procedure for gastro-oesophageal reflux disease. With experience, the duration of operation falls and the hospital stay is shorter. Short-term sympto matic and pH results are consistently improved by surgery.