LAPAROSCOPIC NISSEN FUNDOPLICATION FOR THE TREATMENT OF GASTROESOPHAGEAL REFLUX DISEASE (GERD) - SURGERY AFTER EXTENSIVE CONSERVATIVE TREATMENT

Background: A prospective study was conducted to evaluate the physiolo gic and clinical consequences of laparoscopic Nissen fundoplication (L NF), using strict indications for surgery. Methods: From 1992 to 1997, 50 patients underwent LNF. Indications for operative treatment were e ither failure of conservative treatment or foresight to see long-term use of strong acid suppressive therapy. Patients were evaluated by bar ium esophagogastric study (BES), esophagoscopy, 24-h pH monitoring (pH M), stationary esophageal manometry, gastric-emptying studies (GES), p ancreatic polypeptide stimulation test (PPT) and clinical evaluation u sing questionnaires. Results: Perioperative complications necessitated conversion to laparatomy in two cases, and there was no mortality. Se vere dysphagia resulted in reoperation in two patients. The average ma ximum lower esophageal sphincter pressure (MLESP) increased from 6.1 m mHg to 12.7 mmHg. Endoscopy showed improved grading of the esophagitis , and the total percentage of pH less than 4 during 24 h decreased fro m a mean of 9.2 to 0.95. Three patients demonstrated impaired PPTs pos toperatively; two had (mild) diarrhea. The overall success rate after the operation was 90%. Conclusions: The results of LNF in a limited nu mber of patients with severe and/or resistant gastroesophageal reflux disease (GERD) receiving continuous medical treatment with proton pump inhibitors (PPIs) on a maintenance base are comparable with LNF resul ts in centers with a more liberal policy concerning indications for LN F surgery.