LAPAROSCOPIC NISSEN FUNDOPLICATION - LAPAROSCOPIC DISSECTION TECHNIQUE AND RESULTS

Background/Aims: Proton Pump inhibitors and laparoscopic techniques ha ve had a dramatic impact on the therapy of gastroesophageal reflux dis ease. These techniques have introduced new complications associated wi th the treatment. This study compares the results of a laparoscopic Ni ssen fundoplication with Life-Long proton pump inhibitor treatment. Ma terials and Methods: Between May 1991 and February 1996, 274 patients were treated by laparoscopic Nissen fundoplication (LNF). Two hundred twenty-four patients were included in this prospective study. Thirteen , patients presented stage V esophagitis (Barrett); 4 had esophagitis stage IV; 16 had stage III, 181 had stage II and 11 had stage I. Five trocars were needed for the operation. After mobilization, of the grea ter curvature, a fundic wrap of 5 cm was created and fixed on the esop hagus. Results: Median operating time was 60 min (39-300). There were 5 perioperative complications (a gastric perforation, three pleural pe rforations, and one liver laceration. treated by coagulation). Three c onversions to Laparotomy were necessary. There were 4 early complicati ons: two pulmonary infections and two re-operations; one case of wrap necrosis with peritonitis, and one case of small bowel perforation. Ga stroscopy was performed in 133 cases. The esophagus was normal in 121 cases, an esophagitis stage I was present in 9, esophagitis stage II i n 2, esophagitis stage III in one. Median lower esophageal sphincter p ressure was 10 mmHg (2.9-30) preoperatively and 19 mmHg (9-40) post-op eratively. Median reflux time was 10% (0-65) preoperatively and 1% (0- 38) post-operatively. One hundred fifty-four patients were interviewed with a median follow up of 30 months (1-58). One hundred thirty patie nts were Visick I, 11 Visick II, 8 Visick III and 5 patients needed re -operation; three reoperations because of dysphagia, I because of epig astric pain, and 1 for heartburn recurrence. Conclusions: From these r esults, rue conclude that LNF seems to be an attractive alternative to long term medical treatment.