title: Immediate and delayed effects of laparoscopic Nissen fundoplication on pulmonary function.
abstract: BACKGROUND
  An effort was made to assess the respiratory outcomes of laparoscopic Nissen fundoplication (LNF).
  
  
  METHODS
  Prospective follow-up of 69 patients undergoing LNF for gastroesophageal reflux disease. Outcomes included pulmonary function testing, 24-h pH recording, esophageal manometry, and symptom assessment.
  
  
  RESULTS
  There was an improvement (p < 0.0001) in heartburn and cough scores. There was a significant fall in spirometry (p < 0001), diffusing capacity (p < 0.0001), and respiratory muscle strength (p < 0.0001) 36 h after surgery, which had returned to baseline by 1 month. At 6 months, the patients (n = 16) with impaired preoperative diffusing capacity showed improvement (17.8 +/- 3.7 to 19.8 +/- 4.6 ml/min/mmHg, p = 0.0245).
  
  
  CONCLUSIONS
  Patients undergoing LNF have impaired gas exchange before surgery which tends to improve 6 months after surgery. There is an early reversible impairment in respiratory function due to diaphragm dysfunction. Patients with a preoperative 1-s forced expired volume > 1.5, or 50% predicted, are unlikely to develop significant early respiratory complication.
authors.affiliation: Department of Surgery, St. Joseph's Hospital, McMaster University, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Anvari
authors.forename: C
authors.initials: C
authors.lastname: Allen
authors.forename: L A
authors.initials: LA
authors.lastname: Moran
mesh_terms: D000328:Adult; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011446:Prospective Studies; D012129:Respiratory Function Tests; D015656:Respiratory Mechanics; D012140:Respiratory Tract Diseases / Q000150:complications / Q000503:physiopathology; D013997:Time Factors