Laparoscopic fundoplications for gastrooesophageal reflux disease: experience with 49 surgical patients (1994-1999)

Introduction: Chronic gastrooesophageal reflux disease (GERD) is the most c ommon benign pathology of the upper gastrointestinal tract in the western w orld. We report our experience of laparoscopic antireflux surgery. Patients and methods: 49 patients underwent laparoscopic antireflux surgery at our clinic between 1994 and 1999. 48 patients were followed up in a ret rospective study. Mean follow-up was 30 months (2-66). 31 patients (64.6%) were male and 17 female (35.4%). Mean age was 48 years (26-74). The surgica l method was tailored to the case: total Nissen fundoplication (87.5%) was indicated after ruling out oesophageal motility disorders by manometry. In 6 patients (12.5%) with coexisting dysphagia or pathological manometry, par tial posterior fundoplication (Toupet) was performed. Results: Mean operating time of 215 minutes (125-420) for the first 10 Niss ens was significantly reduced to 119 minutes (70-190) for the last 10 proce dures with increasing experience of the surgeon. No severe intraoperative c omplications occurred and mortality was 0%. Conversion rate was 4.2%. Mean hospital stay was 6.1 days (1-36). At follow-up 93.7% were free of reflux s ymptoms without medication, and only one patient (2.1%) suffered from regul ar reflux which had to be treated with PPI daily. 2 patients (4.2%) took PP I only occasionally. Persistent dysphagia occurred in 7 patients (14.8%). 5 (10.5%) underwent one or more endoscopic dilatations, after which 3 patien ts (6.3%) reported an improvement of dysphagia. No patient needed reoperati on on due to mechanical complications. 1 patient (2.1%) developed a paraoes ophageal hernia 4.5 years after a Nissen procedure. According to the Visick Score, 95.8% of all patients were satisfied with their outcome (Visick I/I I). Conclusions: With careful investigation and indication, laparoscopic antire flux surgery is a safe and effective alternative method to longterm medicat ion with PPI in the treatment of gastrooesophageal reflux disease. Morbidit y is low. Persistent postoperative dysphagia can be reduced with either a s hort and floppy total fundoplication or a partial wrap.