THE TREATMENT OF GASTROESOPHAGEAL REFLUX DISEASE WITH LAPAROSCOPIC NISSEN FUNDOPLICATION - PROSPECTIVE EVALUATION OF 100 PATIENTS WITH TYPICAL SYMPTOMS

Objective To evaluate prospectively the outcome of laparoscopic fundop lication in a large cohort of patients with typical symptoms of gastro esophageal reflux. Summary Background Data The development of laparosc opic fundoplication over the past several years has resulted in renewe d interest in the surgical treatment of gastroesophageal reflux diseas e (GERD). Methods One hundred patients with typical symptoms of GERD w ere studied. The study was limited to patients with positive 24-hour p H studies and ''typical'' symptoms of GERD. Laparoscopic fundoplicatio n was performed when clinical assessment suggested adequate esophageal motility and length. Outcome measures included assessment of the reli ef of the primary symptom responsible for surgery; the patient's and t he physician's evaluation of outcome; quality of life evaluation; repe ated upper endoscopy in 30 patients with presurgical esophagitis; and postsurgical physiologic studies in 28 unselected patients, consisting of 24-hour esophageal pH and lower esophageal sphincter manometry. Re sults Relief of the primary symptom responsible for surgery was achiev ed in 96% of patients at a mean follow-up of 21 months. Seventy-one pa tients were asymptomatic, 24 had minor gastrointestinal symptoms not r equiring medical therapy, 3 had gastrointestinal symptoms requiring me dical therapy, and 2 were worsened by the procedure. Eighty-three pati ents considered themselves cured, 11 were improved, and 1 was worse. O ccasional difficulty swallowing not present before surgery occurred in 7 patients at 3 months, and decreased to 2 patients by 12 months afte r surgery. There were no deaths. Clinically significant complications occurred in four patients. Median hospital stay was 3 days, decreasing from 6.3 in the first 10 patients to 2,3 in the last 10 patients. End oscopic esophagitis healed in 28 of 30 patients who had presurgical es ophagitis and returned for follow-up endoscopy. Twenty-four-hour esoph ageal acid exposure had returned to normal in 26 of 28 patients studie d after surgery. Lower esophageal sphincter pressures had also returne d to normal in all patients, increasing from a median of 5.1 mmHg to 1 4.9 mmHg. Conclusions Laparoscopic Nissen fundoplication provides an e xcellent symptomatic and physiologic outcome in patients with proven g astroesophageal reflux and ''typical'' symptoms. This can be achieved with a hospital stay of 48 hours and a low incidence of postsurgical c omplications.