Laparoscopic Nissen fundoplication - A prospective analysis of 200 consecutive patients

Nissen fundoplication is now the most common antireflux operation for gastr oesophageal reflux disease. This study is a report on the laparoscopically per formed floppy Nissen procedure. Two hundred consecutive patients were a nalyzed (84 women, 116 men, mean age 49 years, mean duration of symptoms 5 years) after laparoscopic Nissen fundoplication between 1992 and 1996. The main indications for surgery were daily heartburn, retrosternal pain, and r egurgitation demanding continuous medical therapy. Eight patients (4%) had esophageal stricture, and 21 (11%) had Barrett's esophagus with intestinal metaplasia. All patients underwent upper gastrointestinal endoscopy, 24-h e sophageal pH monitoring, and esophageal manometry before and 3 months after the operation. In addition, a questionnaire was completed an average of 2. 2 years (range 1.0-4.6) after the operation. The results of the study were as follows: mortality was zero, and the morbidity rate was 5%. The mean hos pital stay was 3.8 +/- 2.8 days, and sick leave was 14.3 +/- 10.4 days. Pos toperatively, esophagitis was healed or significantly improved in all but 4 patients (98%), and 24-h pH and lower esophageal sphincter pressure were n ormal. After 2 years, 87% of the patients had Visick scores of I-II. It is concluded that laparoscopic floppy Nissen fundoplication provides an effici ent and safe alternative for surgical treatment of gastroesophageal reflux disease.