Five- to eight-year outcome of the first laparoscopic Nissen fundoplications

The operative mortality and morbidity: of laparoscopic fundoplication are l ower than fur the open procedure. Questions have been raised regarding its long-term durability One hundred seventy-one pa tit nts who had undergone l aparoscopic Nissen fundoplication at least 5 years previously answered a qu estionnaire. During this period, 291 patients underwent a laparoscopic Niss en fundoplication. Surveillance data were available fur 171 patients at a m ean of 6.4 years after surgery. Overall, 96.5% were satisfied and 3.5% were not satisfied with tile result of the procedure. Persistent symptoms inclu ded abdominal bloating (20.5%), diarrhea (12.3%), regurgitation (6.4%), hea rtburn (5.8%) and chest pain ( 4.1%); 27.5% reported dysphagia, and 7% had required dilatation. Fourteen percent were on continuous proton pump, inhib itor therapy; but 79% of these patients were treated for vague abdominal or chest symptoms unrelated to reflux, which calls into question the indicati ons fur this therapy. Ninety-three percent of all patient were satisfied wi th their decision to have surgery The overall well-being score increased si gnificantly from 2.2 +/- 1.6 before surgery to 8.8 +/- 2 (P >0.0001) at mor e than 5 years after surgery Twenty-one percent had undergone additional di agnostic procedures after surgery such as endoscopy and/or barium swallow L aparoscopic Nissen fundoplication is an excellent long-term treatment for g astroesophageal reflux disease with persistent success for more than 5 year s. Some patients: have continuing symptoms and remain on therapy, but more than 90% of all patients undergoing laparoscopic Nissen fundoplication rema in satisfied with their decision to have surgery These results are at least as good as those achieved with open fundoplication and prove the long-term worth of this procedure.