LAPAROSCOPIC VS CONVENTIONAL NISSEN FUNDOPLICATION - A PROSPECTIVE RANDOMIZED STUDY

Background: Laparoscopic Nissen fundoplication has gained wide accepta nce among surgeons, but the results of the laparoscopic procedure have not been compared to the results of an open fundoplication in a rando mized study. Methods: Some 110 consecutive patients with prolonged sym ptoms of grade II-IV esophagitis were randomized, 55 to laparoscopic ( LAP) and 55 to an open (OPEN) Nissen fundoplication. Postoperative rec overy, complications, and outcome at 3- and 12-month follow-up were co mpared in the two groups. Results: Five LAP operations were converted to open laparotomy due to esophageal perforation (two), technical diff iculties (two), and bleeding (one). In the OPEN group (two) patients u nderwent splenectomy, There was no mortality. The mean hospital stay w as 3.2 days in the LAP group and 6.4 in the OPEN group. Dysphagia and gas bloating were the most common complaints 3 months after the operat ion in both groups, These symptoms had disappeared at the 12-month fol low-up examination. All patients in the LAP group and 86% in the OPEN group were satisfied with the result. Conclusions: Laparoscopic Nissen fundoplication is a safe and feasible procedure. Complications are fe w and functional results are good if not better than those of conventi onal open surgery.