What did the laparoscopic nissen approach of the gastro-oesophageal refluxreally change far the patients 8 years later?

Background : Nissen fundoplication (NF) is recognized as the surgical treat ment of the gastro-oesophageal reflux disease (GERD). NF can be achieved ei ther by open surgery or by laparoscopic approach. Methods: From 1987 to 1997, 210 patients were treated for GERD by NF : 61 b y open and 149 by laparoscopic approach. All the patients were followed mor e than 1 year and were scored by clinical assessment (Visick scale adaptati on). In case of Visick score > 1, GI-endoscopy, X ray series or 24-hour pH- study complete the evaluation. Results: The operative time was comparable between both groups. The postope rative recovery was statistically faster in the laparoscopic group (p = 0.0 001). The mean time of follow up was 6 years after open NF and 4 years afte r laparoscopic NE After open NF or laparoscopic NE 72% and 67% of the patie nts are respectively scored Visick 1,13% and 21% -Visick 2,6.8% and 6% -Vis ick 3 and 8,.2% and 6% Visick 4 (NS). Patients with recurrence of GERD were scored Visick 4, so failure of the surgical treatment is observed in 5 pat ients after open NF and 9 patients after laparoscopic NE The occurrence of incisional hernia was significantly higher in the open group (p = 0.0001). Conclusion : NF remains a safe procedure for surgical treatment of GERD and can be achieved by laparoscopic approach with comparable results to those by open laparotomy. In our experience, the advantages of the laparoscopic a pproach is a faster postoperative recovery and a lower risk of incisional h ernia.