THE SURGICAL OPTION FOR GASTROESOPHAGEAL REFLUX DISEASE

Gastroesophageal reflux disease is a common condition. Most patients c an be managed with medications, but patients with refractory disease, particularly those with an incompetent lower esophageal sphincter, sho uld be referred for surgery. The open Nissen fundoplication cures >90% of patients of their symptoms. The laparoscopic approach was first ap plied for patients with gastroesophageal reflux disease in 1991, and s ince then numerous reports evaluating the early experience with this t echnique have been published with results similar to the open procedur e, Over the last 5 years, 595 laparoscopic antireflux procedures have been performed by us. There was 1 mortality due to an unrecognized duo denal perforation. Splenic injury did not occur compared to an inciden ce of up to 8.5% for the open procedure. A total of 9 patients require d conversion to the open procedure for perforation, bleeding, or disse ction difficulties. However, in the last 350 cases no conversions have been necessary. Most patients are now being discharged from hospital on the day after surgery with some patients being discharged on the sa me day as surgery. The overall reoperation rate, both for early postop erative morbidity and for late poor outcome, was 3.9% with follow-up r anging from 2 months to 5 years, The laparoscopic Nissen fundoplicatio n achieves the same short-term outcome as the open procedure with sign ificantly less postoperative morbidity and a shorter hospital stay. (C ) 1997 by Excerpta Medica, Inc.