IMMEDIATE AND DELAYED-EFFECTS OF LAPAROSCOPIC NISSEN FUNDOPLICATION ON PULMONARY-FUNCTION

Background: An effort was made to assess the respiratory outcomes of l aparoscopic Nissen fundoplication (LNF). Methods: Prospective follow-u p of 69 patients undergoing LNF for gastroesophageal reflux disease. O utcomes included pulmonary function testing, 24-h pH recording, esopha geal manometry, and symptom assessment. Results: There was an improvem ent (p < 0.0001) in heartburn and cough scores. There was a significan t fall in spirometry (p < 0001), diffusing capacity (p < 0.0001), and respiratory muscle strength (p < 0.0001) 36 h after surgery, which had returned to baseline by 1 month. At 6 months, the patients (n = 16) w ith impaired preoperative diffusing capacity showed improvement (17.8 +/- 3.7 to 19.8 +/- 4.6 ml/min/mmHg, p = 0.0245). Conclusion: Patients undergoing LNF have impaired gas exchange before surgery which tends to improve 6 months after surgery. There is an early reversible impair ment in respiratory function due to diaphragm dysfunction. Patients wi th a preoperative 1-s forced expired volume > 1.5, or 50% predicted, a re unlikely to develop significant early respiratory complication.