LAPAROSCOPIC NISSEN FUNDOPLICATION FOR GASTROESOPHAGEAL REFLUX DISEASE

BACKGROUND: This is a retrospective review from March 1994 through Oct ober 1996 of 78 patients who underwent laparoscopic Nissen fundoplicat ion for gastroesophageal reflux disease (GERD). The purpose of this st udy was to evaluate the postoperative results and complications. METHO DS: The patient profile included 38 men and 40 women with a mean age o f 46 years (range 11 to 81). The main preoperative symptoms included h eartburn (92%), respiratory problems (42%), and dysphagia (32%). Preop erative assessment included esophagogastroduodenoscopy, upper gastroin testinal series, esophageal manometry, and 24-hour pH monitoring. Esse ntial indications for surgery included esophagitis (83%), Barrett's es ophagus without dysplasia (22%), and esophageal stricture (23%). All p atients underwent a 360-degree wrap with a Maloney dilator and divisio n of the short gastric vessels. RESULTS: The mean operative time was 2 06 minutes (range 90 to 455). The average time for patients to tolerat e a full liquid diet was 1.2 days, and the mean hospital stay was 2.4 days. Current follow-up, from 3 to 36 months, showed complete resoluti on of heartburn without medications in 67 patients (86%), occasional h eartburn in 8 patients (10%), and slight improvement of heartburn in 3 patients (4%). Five patients with preoperative Barrett's metaplasia s howed no evidence of it postoperatively (n = 2) or marked regression ( n = 3). CONCLUSION: Laparoscopic Nissen fundoplication is the procedur e of choice for patients with complicated GERD. (C) 1997 by Excerpta M edica, Inc.