COMPARISON OF OUTCOMES OF OPEN VERSUS LAPAROSCOPIC NISSEN FUNDOPLICATION PERFORMED IN A SINGLE PRACTICE

BACKGROUND: We reviewed Nissen fundoplications performed in a single p ractice from January 1989 to March 1997, encompassing our transition f rom open to laparoscopic procedures. Because all operations were done by two surgeons in the same two hospitals, the study is well controlle d for comparisons. METHODS: Records of 271 consecutive patients were r eviewed. RESULTS: From 1989 to 1992 all patients underwent open fundop lication (n = 78). Thereafter, with increasing frequency, laparoscopic fundoplication was performed. The laparoscopic group was slightly you nger (48 +/- 14 years) than the open group (54 +/- 13 years), but gend er distribution and body mass index (BMI) did not differ. Mean operati ng time for laparoscopic cases was 163 +/- 58 minutes compared with 14 8 +/- 59 minutes for open cases (NS). Intraoperative complication rate was 8% for both groups. Length of hospitalization was shorter for pat ients undergoing laparoscopic surgery (2.4 days versus 7.2 for open pr ocedures, P <0.05). In follow-up, 82% of the open Nissen group were as ymptomatic compared with 84% of the laparoscopic Nissen group. The sam e proportion of patients required reoperation for dysphagia (3% for ea ch group). Of patients who had the open procedure, 21% had wound compl ications, None of those treated laparoscopically had long-term morbidi ty from trocar insertion sites. CONCLUSION: Equal effectiveness in tre ating reflux combined with shorter hospitalization and absence of woun d complications makes the laparoscopic approach the preferred method f or performing fundoplication, (C) 1998 by Excerpta Medica, Inc.