Dysphagia and oesophageal clearance after laparoscopic versus open nissen fundoplication. A randomized, prospective trial

Background: An increase in postoperative dysphagia has been reported after laparoscopic fundoplication. Our aim was to compare laparoscopic Nissen-Ros setti fundoplication to open fundoplication regarding oesophageal clearance and dysphagia in a prospective, randomized study. Methods: Twenty eight co nsecutive patients with objectively observed gastro-oesophageal reflux dise ase referred to operative treatment were randomized to laparoscopic (13) or open (15) fundoplication. A standard formula was used in pre- and postoper ative interview. Oesophageal clearance was measured by liquid bolus radionu clide transit before and 3 days, 1 month and 1 year after fundoplication. E ndoscopy was done preoperatively and 1 year after the operation. Results: H eartburn. regurgitation and ooesophagitis were cured with equal effectivene ss (p = 0.001). New-onset dysphagia was observed in nine (69%) of the patie nts in the laparoscopic group and in nine (60%) in the open group during th e first postoperative month. Food impaction occurred in four (31%) cases af ter laparoscopic and in two (13%) after open surgery (ns). One year after t he operation, one patient (8%) in both groups had more than mild symptoms. Oesophageal radionuclide transit remained normal after open fundoplication, but after the laparoscopic procedure oesophageal clearance was disturbed-o nly one patient did not have a pathologic result during the first postopera tive month. One year after the operation, clearance was normal. Conclusions : After laparoscopic operation, a tendency to more severe new-onset dysphag ia was observed, and oesophageal clearance was transiently disturbed. Effor ts should be made to minimize postoperative swallowing and clearance distur bances after laparoscopic fundoplication in order to get the full value out of otherwise more rapid recovery.