RESOLVING GASTROESOPHAGEAL REFLUX WITH LAPAROSCOPIC FUNDOPLICATION - FINDINGS IN 138 CASES

Background: The purpose of this study was to evaluate the results of 1 38 cases of gastroesophageal reflux disease resolved laparoscopically with the Rossetti modification of the Nissen fundoplication and to com pare them with findings from other studies in an effort to evaluate th e procedure's ability to transfer from an academic setting to a commun ity hospital setting. Methods: We performed laparoscopic Nissen fundop lication on 138 patients and followed them for up to 45 months. Measur es included postoperative reflux persistence, complications, operating time, length of hospital stay, and others. These findings were compar ed, using the Fisher's exact test, chi-square test, and the two-sample t-test, with results from other studies using open and laparoscopic p rocedures. Results: No patient undergoing laparoscopic fundoplication experienced gastroesophageal reflux after surgery. Complications, not statistically significantly different from those in other studies, occ urred in 15 (10.9%), and conversion to an open procedure was required in two (1.5%). The most common postoperative complaint has been dyspha gia (21.7%). Operative time averaged 70.6 min, decreasing from an aver age of 236 min for the first 10 cases to 40.8 min for the last 10. Thi s measure was statistically significantly lower than all other operati ve times to which it was compared, except one to which it was almost i dentical (69.9 min). Length of stay (LOS) averaged 2.3 days, ranging f rom a low of 7 h to a high of 9 days, which made it fall well within l imits set by other studies. Overall, LOS fell from a 3.0-day average f or the first 20 cases to a 1.9-day average for the last 20 cases. Conc lusions: Laparoscopic Nissen fundoplication resolved gastroesophageal reflux in all 138 patients, and measures for complications, operating time, and LOS were well within values reported by other studies, indic ating the ability of this procedure to be successfully transferred fro m academic medical centers to the community hospital setting.