Management and outcome of complications after laparoscopic antireflux operations

Hypothesis: Perioperative complications of laparoscopic antireflux operatio ns are infrequent and treatable and do not cause permanent disability. Design: Retrospective review of all patients with laparoscopic antireflux o perations for the management and outcome of all complications. Setting: University medical center. Patients: All 538 patients who underwent operation from January 20, 1993, t hrough December 28, 1999. Main Outcome Measures: Complications were defined as any major or minor dev iation from the standard postoperative clinical pathway. Minor complication s did not require invasive treatment and were not expected to result in per manent disability. Major complications required invasive treatment or could result in permanent disability. The frequency of complications was also st ratified into those that occurred during primary antireflux procedures and those that occurred during reoperations for previously failed procedures. Results: Ninety-two complications occurred in 538 operations (17.1%). Sixty -eight patients (12.6%) experienced minor complications. Postoperative ileu s was the most common complication (n=37 [6.9%]), followed by pneumothorax (n=13 [2.4%]) and urinary retention (n=10 [1.9%]). Major complications were present in only 24 patients (4.5%) and occurred significantly more frequen tly after reoperations, Of these, dysphagia was the most frequent complicat ion observed (n = 11 [2.0%]), followed by perforated viscus (n=4 [0.7%]). T wo patients (0.4%) died. All but 4 major complications resulted in full rec overy. Conclusions: Major complications in laparoscopic antireflux surgery are rar e, their treatment is straightforward, and permanent disability is uncommon . Complications occur twice as often during reoperations, highlighting the difficulty in performing these procedures. Although primary laparoscopic an tireflux operations are performed by many general surgeons routinely, reope rations should be performed by a team experienced in laparoscopic esophagea l surgery.