LAPAROSCOPIC NISSEN FUNDOPLICATION - WHERE DO WE STAND

Laparoscopic Nissen fundoplication was first performed in 1991. With t he increasing number of these procedures being performed it is appropr iate to review the published short-term results. A retrospective revie w of reports on this subject was performed. There were a total of 2453 patients available for review. Twenty-five of 2453 (1.0%) patients ha d an esophageal or gastric perforation and 28 of 2453 (1.1%) patients required transfusion for bleeding. Forty-nine of 2453 (2%) patients de veloped a pneumothorax. Two of 2453 (0.1%) patients required a splenec tomy. Conversion to the open procedure was necessary in 5.8% (143 of 2 453) of patients. The laparoscopic approach is associated with minimal postoperative morbidity. Four of 2453 (0.2%) needed further early sur gery for persistent bleeding, 11 of 2453 (0.4%) for a missed perforati on, 22 of 2453 (0.9%) for crural disruption, paraesophageal herniation , or gastric volvulus. Four of 2453 (0.2%) patients died of either a m issed duodenal perforation, a missed esophageal perforation, ischemic bowel with mesenteric thrombosis, or myocardial infarction. Early post operative dysphagia occurred in 500 of 2453 (20.3%) patients. Late pos toperative dysphagia occurred in 114 of 2068 (5.5%), with the need for dilatation in 72 of 2068 (3.5%). Endoscopy was required for food impa ction in 11 of 2068 (0.5%) and re-operation for dysphagia occurred in 18 of 2068 (0.9%). Fifty-seven of 1658 (3.4%) patients developed reflu x symptoms and 11 of 1658 (0.7%) required revisional surgery. Satisfac tion rates ranged from 87 to 100%. In the short term, laparoscopic fun doplication can be performed with less morbidity and mortality than th e open procedure. It is superior to medical therapy. Long-term followu p is awaited.