ANTIREFLUX SURGERY - A CURRENT COMPARISON OF OPEN AND LAPAROSCOPIC APPROACHES

The technologic advances of laparoscopic surgery have recently resulte d in a renaissance of antireflux surgery as a minimal invasive alterna tive to life long medical treatment in patients with gastroesophageal reflux disease. The now vast experience has shown that, in experienced hands, laparoscopic antireflux surgery is feasible, shortens the hosp ital stay and recovery period, and provides a cosmetically more satisf ying result than the open procedures. The rate of intra- and postopera tive complications of laparoscopic antireflux procedures is, however, not significantly lower than that reported after open procedures. The laparoscopic approach is even associated with some additional sources for complications, i.e., trocar injuries, perforations of the esophago gastric junction, and herniation of the repair into the chest with a s ignificant rate of early reoperations. Short term and intermediate res ults of laparoscopic antireflux procedures appear comparable to those obtained with the procedures performed via a laparotomy. Whether this is also true for the long term outcome will have to be shown by the fo llow-up of the large series of laparoscopic antireflux procedures that have been performed in the recent years. Before these data are availa ble, one should be careful not to widen the indications for antireflux surgery just because the procedure can now be performed laparoscopica lly.