CLINICAL AND PHYSIOLOGICAL COMPARISON OF LAPAROSCOPIC AND OPEN NISSENFUNDOPLICATION

BACKGROUND: Although recent reports have documented the safety and eff icacy of laparoscopic fundoplication, none have compared outcomes to t hat of open Nissen fundoplication, STUDY DESIGN; Eighty-one patients h ad either open (n=47) or laparoscopic (n=34) Nissen fundoplication. Re lief of symptoms was measured by a standardized questionnaire and scor ed by a modified Visick-Index, Physiologic outcome was assessed by pos toperative pH monitoring and manometry in a subset of both groups, RES ULTS: Primary symptoms were heartburn in 55 percent of the patients, r egurgitation in 9 percent, dysphagia in 11 percent, and atypical in 25 percent of patients, Twenty-seven (84 percent) of 32 patients in the laparoscopic group and 31 (84 percent) of 37 patients in the open grou p were cured or improved, Operative time was significantly longer in t he laparoscopic group (218 compared to 168 minutes), The period of hos pitalization was shorter for the laparoscopic group (4.7 compared to 9 .2 days, p<0.0001), Postoperative pressures in the lower esophageal sp hincter (LES) were significantly higher in the laparoscopic group (20. 9 compared to 12.1, p=0.008), Augmentation of sphincter length was sim ilar for both groups, More patients in the laparoscopic group failed t o relax their LES completely after fundoplication (32 compared to 71 p ercent, p=0.1),CONCLUSIONS: Symptomatic outcome after laparoscopic fun doplication is similar to that of open surgery. Physiologic studies re veal a greater augmentation of LES pressure and a low prevalence of sp hincter relaxation after laparoscopic fundoplication.