Effective treatment of symptomatic gastroesophageal reflux disease by laparoscopic fundoplication

Objective: To evaluate the outcome of our initial experience with laparosco pic fundoplication. Methods: Surgery was indicated if reflux disease was confirmed and,more tha n 6 months of conservative treatment had failed. Nissen fundoplication was applied as the standard procedure, however, if motility disorders of the es ophageal body were present partial Toupet fundoplication was performed. Results: Sixty-seven patients with a median age of 51 (27-78) years were tr eated with laparoscopic fundoplication. Patients reported typical complaint s for 7 (0.5-50) years. Endoscopy revealed 58 patients with esophagitis. At manometry, the median resting pressure of the lower esophageal sphincter w as 3 mmHg (normal: 6-25 mmHg). pH-monitoring, confirmed significant reflux with a median preoperative DeMeester score of 53.9 (normal: < 14.7). Median operation time was 105 (50-230) minutes, Conversion was necessary in 2 (3% ) patients. Postoperative hospital stay was 4 (2-20) days. Mortality was 0% . The first 34 patients were followed retrospectively, all others prospecti vely, At follow-up (14 (0.5 - 66) months) 95% of patients were symptom free and satisfied with the procedure including 3 patients who were reoperated laparoscopically for recurrent disease. Conclusion: Laparoscopic fundoplication can effectively treat gastroesophag eal reflux disease. It can be performed safely with minimum patient discomf ort.