Laparoscopic Nissen fundoplication - Five-year results and beyond

Hypothesis: Laparoscopic Nissen fundoplication provides long-term relief of symptoms of gastroesophageal reflux disease. Design: Prospectively evaluated case series. Setting: University teaching hospital. Patients: From September 1991 to December 1999, we performed more than 900 laparoscopic antireflux procedures. The outcome for patients who underwent surgery between September 1991 and June 1994 (178 cases) was determined. Th is included all patients having laparoscopic Nissen fundoplication, from th e first procedure onward. Interventions: Long-term follow-up for 5 or more years after laparoscopic N issen fundoplication was obtained by an independent investigator who interv iewed patients using a structured questionnaire. Main Outcome Measures: Pro spective evaluation of clinical symptoms using a structured questionnaire. Results: Outcome data covering a period of 5 or more years after surgery wa s available for 176 patients (99%), with 2 patients lost to follow-up. Nine patients died (8 of unrelated causes) at some stage following surgery, and the outcome was difficult to determine in 1 patient: with cerebral palsy. Hence, questionnaire data were available for 166 patients at a median follo w-up of 6 years (range, 5-8 years). Three patients (1.7%) underwent revisio n surgery for recurrent reflux; 87% of the 176 patients remained free of si gnificant reflux. Reoperation was required for dysphagia in 7 patients (3.9 %), 2 for a tight wrap and 5 for a tight diaphragmatic hiatus. In addition, reoperation was necessary for a paraesophageal hiatus hernia in 13 patient s (7.3%). Of the reoperations, 56% were performed within 12 months of the o riginal procedure, and 22% during the second year of follow-up. Further sur gery was uncommon after 2 years. The long-term outcome was considered "good or excellent" by 90% of patients. Conclusions: The long-term outcome of laparoscopic Nissen fundoplication is similar to that following open fundoplication. Good results are obtained i n most patients.