Effectiveness of laparoscopic fundoplication for gastro-oesophageal reflux

Background: Gastro-oesophageal reflux (GERD) is a common condition. Many pa tients respond to conservative therapy. Severe symptomatic cases and those who fail medical treatment are referred to surgery. The long-term results o f open fundoplication surgery have been good with a more than 90% response after 10 years of follow-up. The introduction of laparoscopic fundoplicatio n achieved the same results with shorter hospital stay, a better cosmetic r esult and less cost to the health care providers. Patients and Methods: 74 patients who failed medical treatment for GERD wer e treated by laparoscopic fundoplication. The Toupet procedure was performe d in 66 of these patients, the others patients had a Nissen-type fundoplica tion. The patients were followed up for a mean period (+/- SD) of 14.8 +/- 8.8 months (range 3-33 months). Results: Most of the patients were males (n = 65). The mean age (+/- SD) of all the patients was 36.1 +/- 9.5 years (range 17-60 years). The majority (93.8%) reported disappearance of symptoms and are not using any antireflux medications. Five patients (6.7%) are considered failures of the procedure s. Of these, three patients developed recurrence of reflux symptoms during the follow-up period. The other two patients developed complications, i.e. gas bloat, persistent vomiting and dysphagia which warranted taking down th e wraps laparoscopically. Two patients developed a small incisional hernia at the site of the 10 mm port. The mean of hospital stay If SD) was 3.1 +/- 1.3 days (range 1-7 days). Conclusion: Laparoscopic fundoplication is safe and effectively relieves re flux symptoms in patients who fail medical treatment.