LAPAROSCOPIC NISSEN FUNDOPLICATION - 2-YEAR COMPREHENSIVE FOLLOW-UP OF A TECHNIQUE OF MINIMAL PARAESOPHAGEAL DISSECTION

Objective To provide a comprehensive follow-up of 381 patients after l aparoscopic Nissen fundoplication (INF) using a technique of minimal p araesophageal dissection. Methods Patients underwent a 24-hour pH reco rding, esophageal manometry, and symptom score assessment for six symp toms of gastroesophageal reflux disease preoperatively. To date, 260 p atients have undergone repeat studies at 6 months and 108 patients at 2 years. Results LNF was associated with a significant (p < 0.0001) in crease in the lower esophageal sphincter (LES) pressure and a signific ant (p < 0.0001) drop in duration of acid reflux in 24 hours and sympt om score 6 and 24 months after surgery when compared to preoperative v alues. Twelve patients (3%) have experienced recurrence of reflux symp toms, 8 presenting in the first 6 months and 4 by the second year afte r surgery, but only 1 has required repeat surgery. The incidence of cl inical dysphagia was found to be 1.3% of the patient group. Conclusion s LNF remains an effective antireflux procedure at 2 years. Most recur rences occur early, and there is no significant deterioration in the h igh-pressure zone at the LES, the percentage reflux in 24 hours, or sy mptom control between 6 months and 2 years after surgery, suggesting t hat the long-term results should be satisfactory.