title: Laparoscopic Nissen fundoplication is an effective treatment for gastroesophageal reflux disease.
abstract: OBJECTIVE
  The open Nissen fundoplication is effective therapy for gastroesophageal reflux disease. In this study, the outcomes in 198 patients treated with the laparoscopic Nissen fundoplication was evaluated for up to 32 months after surgery to ascertain whether similar positive results could be obtained.
  
  
  BACKGROUND
  To ensure surgical success, patients were required to have mechanically defective sphincters on manometry and increased esophageal acid exposure on 24-hour pH monitoring. The patients either had severe complications of gastroesophageal reflux disease or had failed medical therapy. These requirements have been found to be necessary to ensure a successful surgical outcome.
  
  
  METHODS
  The disease was complicated by ulceration (46), stricture (25) and Barrett's esophagus (33). Patients underwent standard Nissen fundoplications identical in every detail to open procedures except that the procedures were carried out by the laparoscopic route.
  
  
  RESULTS
  Perioperative complications included gastric or esophageal perforation (3), pneumothorax (2), bleeding (2), breakdown of crural repair (2) and periesophageal abscess (1). The only mortality occurred from a duodenal perforation. Six patients required conversion to the open procedure. The median hospital stay was 3 days. One hundred patients were observed for follow-up for 6 to 32 months (median 12 months), with outcomes similar to the open Nissen fundoplication. Further surgery was required for two patients who had recurrent gastroesophageal reflux and one who developed an esophageal stricture. Ninety-seven percent are satisfied with their decision to have the operation.
  
  
  CONCLUSIONS
  The laparoscopic Nissen fundoplication can be carried out safely and effectively with similar positive results to the open procedure and with all of the advantages of the minimally invasive approach.
authors.affiliation: Department of Surgery, Creighton University School of Medicine, Omaha, Nebraska.
authors.forename: R A
authors.initials: RA
authors.lastname: Hinder
authors.forename: C J
authors.initials: CJ
authors.lastname: Filipi
authors.forename: G
authors.initials: G
authors.lastname: Wetscher
authors.forename: P
authors.initials: P
authors.lastname: Neary
authors.forename: T R
authors.initials: TR
authors.lastname: DeMeester
authors.forename: G
authors.initials: G
authors.lastname: Perdikis
mesh_terms: D000768:Anesthesia, General; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008365:Manometry; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome