title: Laparoscopic Nissen fundoplication: operative results and short-term follow-up.
abstract: The operative results, outcome, and short-term follow-up after laparoscopic exploration for Nissen fundoplication were evaluated in 35 patients with symptomatic gastroesophageal reflux and reflux-induced pulmonary disease. There were 19 female and 16 male patients, ranging in age from 17 to 72 years (mean: 42 years, SD: 11.6 years). In 20 patients, the symptoms were predominantly of regurgitation and heartburn; the remaining 15 patients had mixed regurgitation/heartburn and pulmonary symptoms. All patients underwent 24-hour pH monitoring, upper endoscopy, and manometry. The indication for surgery was medical failure or the need for long-term medical management with omeprazole. The operation, which was performed laparoscopically, is identical to the conventional Nissen fundoplication. There was a mortality rate of 0% and a morbidity rate of 25.7%. Five patients required conversion to open Nissen fundoplication, which was due to hemodynamic instability secondary to presumed pneumothorax in three patients and colotomy and a distal esophageal perforation in the other two patients. Thirty patients underwent laparoscopic Nissen fundoplication. Three patients developed early dysphagia, and one patient experienced a perforation of the piriform sinus due to nasogastric tube manipulation under anesthesia. All these patients had an uncomplicated postoperative course, and there was no long-term disability. The total surgical time of laparoscopic Nissen fundoplication was on average 107 minutes (SD: 35.3 minutes). Discharge usually occurred on the evening of postoperative day 2 (mean: 3.3 days; SD: 1.5 days). Twenty-six of the 30 patients who underwent laparoscopic Nissen fundoplication described the outcome as excellent and good (87%); however, 4 patients (13%) were unsatisfied. Fifteen patients (50%) had difficulty belching or vomiting, and moderate dysphagia was described by 7 patients (24%) in follow-up. Regurgitation and heartburn were cured in 96%, whereas reflux-induced pulmonary disease was cured in 50%. The results of laparoscopic Nissen fundoplication compare favorably with those of conventional Nissen fundoplication with respect to mortality, complications, and outcome.
authors.affiliation: Department of General and Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina 27710.
authors.forename: H B
authors.initials: HB
authors.lastname: Bittner
authors.forename: W C
authors.initials: WC
authors.lastname: Meyers
authors.forename: S R
authors.initials: SR
authors.lastname: Brazer
authors.forename: T N
authors.initials: TN
authors.lastname: Pappas
mesh_terms: D000328:Adult; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005748:Gastric Fundus / Q000601:surgery*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008171:Lung Diseases / Q000209:etiology; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome