Functional outcome after laparoscopic or open nissen fundoplication - A follow-up study

Objective: To compare the results of open and laparoscopic fundoplication. Design: Nonrandomized controlled study with a 3-year follow-up. Patients and Methods: Fifty-seven consecutive patients with erosive reflux esophagitis underwent laparoscopic (30 patients) or open (27 patients) fund oplication. Interventions: interview by an independent person. In addition, 52 patients (91%) underwent postoperative endoscopy, and 38 patients (67%) underwent e sophageal 24-hour pH recording. Results: Temporary dysphagia was reported by 20 patients (67%) after laparo scopy and by 11 (41%) after open fundoplication (P = .05). There were no di fferences between groups concerning incidence of persistent dysphagia (20% vs 18%, respectively) and mild to no reflux symptoms (97% vs 100%, respecti vely). In addition, bloating (50% vs 63%, respectively) and increased flatu s (77% vs 78%, respectively) were equally common. Visual analog scale score s for dysphagia, bloating, and increased flatus were 0.6, 2.4, and 4.3, res pectively, in the laparoscopic and 0.6, 3.5, and 3.4, respectively, in the open groups. Normal belching ability was reported by 12 patients (40%) afte r laparoscopic and by 20 (74%) after open fundoplication (P = .01). Visick grade 1 or 2 was reported by 21 patients (70%) after laparoscopic and by 24 (89%) after open fundoplication (P = .08). Defective fundic wrap was detec ted in 4 patients (13%) in the laparoscopic and in none in the open group. In addition, abnormal results of 24-hour pH recording were found in 4 patie nts (22%) after laparoscopic and in 2 (10.5%) after open fundoplication. Conclusion: From a functional point of view, both techniques were equally e ffective except concerning belching ability and temporary dysphagia.