Success of laparoscopic fundoplication for gastroesophageal reflux disease

Background. We explored the efficacy of laparoscopic fundoplication (LF) in patients with uncomplicated, medically recalcitrant pathologic gastroesoph ageal reflux disease (GERD) for whom we previously would have recommended o pen surgical repair. Methods. From January 1994 to January 1998, rue performed LF on 150 patient s (80 men and 70 women) with GERD recalcitrant to maximal medical therapy. No patient suffered from esophageal stricture or epithelial dysplasia; howe ver 16% (24 of 150) had benign Barrett's mucosa. Preoperative esophageal ma nometry and 24-hour pH testing were obtained in 93% (139 of 150) and 89% (1 34 of 150) of patients, respectively. Nissen LF (n = 123), Toupet LF (n = 2 6), or Dor LF (n = 1) were accomplished over a large (54 F) intraesophageal bougie. Preoperative (1 month) and postoperative (>6 month) symptom scorin g were assessed on a 0 to 10 scale. Thirty-eight patients with a greater th an 6-month postoperative period had manometry and pH studies performed. Results. The laparoscopic approach was successful in 99% (148 of 150) of pa tients, and there has been no mortality. Operative time was 160 +/- 59 minu tes. Open conversion was required for 2 patients: because of difficulty wit h dissection owing to adhesions in I case and due to perforation in another . Reoperation was required for 5 patients (1 paraesophageal, 2 dysphagia, 2 recurrent reflux). Major postoperative complications involved stroke and p ancreatitis in 1 patient each. Mean hospital stay was 2.6 +/- 1.2 days, ful l activity resumed by 7 days. postoperative esophageal pH testing among 38 patients tested more than 6 months after operation demonstrated normal esop hageal acid exposure in all but 2. GERD symptoms were relieved at 1 month, 6 months, and after 1 year in 95% (128 of 135), 94% (99 of 105), and 93% (6 5 of 70) of patients, respectively. Conclusions. Intermediate-term results with LF suggest this to be a reasona ble approach to surgical management of medically recalcitrant uncomplicated GERD. Thoracic surgeons interested in GERD should become familiar with min imally invasive surgical approaches. (C) 1998 by The Society of Thoracic Su rgeons.