RESULTS OF LAPAROSCOPIC NISSEN FUNDOPLICATION

BACKGROUND/AIMS: Laparoscopic surgery for treatment of gastroesophagea l reflux disease was first described 5 years ago. The more widespread technique is the Nissen fundoplication with its different modification s. The early results suggest that this operation is equivalent in effi cacy to the open antireflux operations. METHODOLOGY: Over a 5 year per iod, 622 patients underwent laparoscopic fundoplication for gastroesop hageal reflux disease. Five hundred and fifty patients underwent Nisse n fundoplication. Preoperative, operative and postoperative data were prospectively reviewed. One hundred twenty seven patients were evaluat ed 1 to 4 years after the operation. RESULTS: Laparoscopic Nissen fund oplication with standard gastric mobilisation and without division of the SGV was performed during the first three years of the laparoscopic approach. Since early 1994, we applied division of the SGV with compl ete mobilisation of the upper part of the gastric fundus in all the pa tients. The mean operative time was 86 minutes (range 30 - 180 minutes ). Conversion to open surgery was necessary in 5 patients (0.9%). Ther e was neither incidence of splenic trauma nor esophageal perforation. There was no mortality. Morbidity was 2.3%. Mean hospital stay was 3.1 days (range 1-13 days). Postoperative dysphagia was observed in all t he patients and resolved after 2 to 6 weeks in all but 12 patients (2. 1%) who were submitted to endoscopic dilatation with success in 9 pati ents. At a median follow-up period of 2 years (16- 44 months), 127 con secutive patients from the initial experience ( series 1991-1992) volu nteerd for mid term follow-up evaluation. We obtained Visick I and II grading in 92% of the patients. Reoperation for failure has been neces sary in 6 patients (1.0%). CONCLUSIONS: The long term results of lapar oscopic Nissen fundoplication are not yet available. The incidence of poor long term outcome or recurrence of symptoms cannot be assessed. A t present, we feel that, in experienced hands, the laparoscopic operat ion is as good as the open procedure if all the surgical principles of antireflux surgery are respected. One of our complications is related to the choice of the operative technique and that highlights the abso lute necessity of strict preoperative assessment and selection of the patient but also selection of the type of operation, tailored to the p atient.