Outcome of laparoscopic anterior 180-degree partial fundoplication for gastroesophageal reflux disease

Although Nissen fundoplication controls gastroesophageal reflux disease eff ectively, it is associated with an incidence of side effects. For this reas on we have investigated the use of a laparoscopic 180-degree anterior fundo plication as a technique that has the potential to control reflux, but with less associated postoperative dysphagia and fewer gas-related side effects . Good short-term (6-month) outcomes have been previously reported within t he context of a randomized trial. This report details the technique we used and describes the outcome of this procedure with longer follow-up in a muc h larger group of patients. The outcome for patients with gastroesophageal reflux disease who underwent a laparoscopic anterior 180-hemifundoplication was determined. Clinical follow-up was carried out prospectively by an ind ependent scientist who applied a standardized questionnaire yearly followin g surgery. This questionnaire evaluated symptoms of reflux, postoperative p roblems including dysphagia, gas bloat, ability to belch, and overall satis faction with clinical outcome. From July 1995 to May 1999, a total of 107 p atients underwent a laparoscopic anterior hemifundoplication. Four patients underwent further surgery for recurrent heartburn, and persistent troubles ome dysphagia occurred in one. At 1 year 89% of patients remained free of r eflux symptoms, and at 3 years 84% remained symptom free. Of those with sym ptoms of reflux, approximately half of them had only mild symptoms. The ove rall incidence and severity of dysphagia for liquids and solids was not alt ered by partial fundoplication. Epigastric bloating that could not be relie ved by belching was uncommon, and only 11% of the patients at I year and 10 % at 3 years following surgery were unable to belch normally. Overall satis faction with the outcome of surgery remained high at 3 years' follow-up. La paroscopic anterior partial fundoplication is an effective operation for ga stroesophageal reflux, with a low incidence of side effects and a good over all outcome.