LAPAROSCOPIC FUNDOPLICATION - A 3-YEAR REVIEW

Laparoscopic treatment of gastroesophageal reflux disease provides dec reased postoperative pain and shortens hospitalization. Experience wit h this procedure continues to grow. The charts of patients who had lap aroscopic fundoplication for the treatment of symptomatic refractory g astroesophageal reflux over a three year period were reviewed. Age, se x, preoperative evaluation, surgical technique, length of procedure, l ength of hospitalization, time to regular diet, conversion to laparoto my, complications, and long-term outcome were analyzed. Eighty-eight p atients, 39 females and 49 males, underwent laparoscopic gastric fundo plication. All patients had symptomatic gastroesophageal reflux. Preop erative evaluation including upper endoscopy demonstrated esophagitis in 71 patients (81%) with changes of Barrett's esophagitis in 12 patie nts (14%). Decreased lower esophageal sphincter pressures were found i n 33 of 73 patients (45%) and none had abnormal motility identified. A 2-3 cm fundoplication with nonabsorbable suture was performed over a large dilator. Mean operative time was 109 minutes. The mean length of hospitalization was 1.9 days in patients completed laparoscopically a nd six days in the 3 patients that required conversion to celiotomy fo r completion of their fundoplication. A clear liquid diet was offered the evening of surgery and advanced to regular as tolerated. Mild dysp hagia was found in most patients for the first week and full liquid or soft diet was prescribed. All but seven patients advanced to regular diet by two weeks. Operative complications occurred in four patients a nd included two pneumothoraces and two esophageal perforations. Follow -up to 40 months has identified one partial wrap disruption and one cr ural breakdown both repaired laparoscopically. Seventy-seven patients (88%) have remained asymptomatic and off all medication. Laparoscopic fundoplication is safe and effective, allowing the benefits of minimal access surgery, including decreased postoperative pain and disability .