Conversions and complications of laparoscopic treatment of gastroesophageal reflux disease. Formation for the Development of Laparoscopic Surgery for Gastroesophageal Reflux Disease Group.
BACKGROUND
It is now known that laparoscopic surgery is associated with less discomfort and less pain during the patient's postoperative course. Laparoscopic treatment of gastroesophageal reflux disease (GERD) is technically feasible. The advantages of this minimally invasive surgical route seem well adapted to a basically functional surgery. However, it is important to know whether laparoscopic access adds a specific risk to this type of surgery.


METHODS
A retrospective survey was conducted among members of the Formation for the Development of Laparoscopic Surgery (FDCL) group during 1993. A form was filled in anonymously for each patient who had had either a conversion or a postoperative complication following a laparoscopic procedure for GERD. Items concerned preoperative workup, technical details of surgery, and postoperative course. Another form was used to ascertain how many surgical procedures for GERD had been performed during the same period, either laparoscopically or via an elective laparotomy. Nineteen surgeons from the FDCL group took part in the study. From 1991 to 1993, 758 patients underwent a laparoscopic procedure for GERD, while during the same period 38 patients underwent an elective laparotomy.


RESULTS
In the laparoscopic group, there were 294 Nissen, 334 Nissen-Rossetti, and 106 Toupet procedures, and 24 Angelchik prosthesis placements. No deaths occurred. The operation had to be converted to an open procedure in 32 cases (4.2% conversion rate). In 7 cases the conversion was due to an intraoperative complication, whereas in 25 cases the conversion was done because of technical difficulties. In 6 cases an intraoperative complication was treated laparoscopically without conversion. Thirty post-operative complications were recorded (morbidity 4%), leading to a reoperation in 12 cases. Five major complications were observed: 2 esophageal perforations, 2 gastric perforations, and 1 bowel perforation.


CONCLUSIONS
These results compare favorably with those of open surgery and suggest that laparoscopic treatment of GERD is as safe as open surgery when performed by a surgeon experienced in laparoscopy.
Collet
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General and Digestive Surgery Service, Center for Laparoscopic Surgery, Bordeaux, France.
Cadière
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GB
D016009:Chi-Square Distribution; D004939:Esophageal Perforation / Q000209:etiology; D018662:Fundoplication / Q000379:methods; D005764:Gastroesophageal Reflux / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000009:adverse effects* / Q000401:mortality / Q000706:statistics & numerical data; D012086:Reoperation; D012189:Retrospective Studies; D013270:Stomach / Q000293:injuries