title: Early laparoscopic Nissen fundoplication for recurrent reflux esophagitis: a cost-effective alternative to omeprazole.
abstract: BACKGROUND
  Eighty percent of patients treated medically for gastroesophageal reflux disease relapse after treatment. Many of these patients require indefinite treatment with omeprazole to prevent recurrence. Nissen fundoplication has been shown to be effective, safe and cost effective in the management of gastroesophageal reflux disease. We suggest a treatment algorithm, which encourages early surgical intervention in cases of recurrent esophagitis after a previously successful two-month course of omeprazole.
  
  
  METHODS
  We have offered laparoscopic Nissen fundoplication since 1993. Patients who received Nissen fundoplication since 1990 were asked to report return to baseline activity, medications, and lifestyle changes. Concurrent chart review of patients treated with omeprazole was conducted to analyze cost.
  
  
  RESULTS
  Patients receiving laparoscopic Nissen fundoplication were discharged significantly sooner and spent significantly less time convalescing when compared to those who underwent open Nissen fundoplication. Laparoscopic Nissen fundoplication became cost effective at 1.5 to 2 years when compared to omeprazole.
  
  
  CONCLUSIONS
  Based on cost analysis, patient satisfaction, acceptable complication rate, and efficient use of time and resources, we recommend laparoscopic Nissen fundoplication as the appropriate treatment in patients who develop recurrent esophagitis after a two-month treatment with omeprazole.
authors.affiliation: Department of Surgery, General Surgery Service, William Beaumont Army Medical Center, El Paso, TX 79920, USA.
authors.forename: S C
authors.initials: SC
authors.lastname: Nessen
authors.forename: J
authors.initials: J
authors.lastname: Holcomb
authors.forename: B
authors.initials: B
authors.lastname: Tonkinson
authors.forename: S P
authors.initials: SP
authors.lastname: Hetz
authors.forename: M A
authors.initials: MA
authors.lastname: Schreiber
mesh_terms: D000465:Algorithms; D003362:Cost-Benefit Analysis; D004791:Enzyme Inhibitors / Q000191:economics / Q000627:therapeutic use*; D004942:Esophagitis, Peptic / Q000601:surgery*; D018662:Fundoplication / Q000191:economics*; D006801:Humans; D010535:Laparoscopy / Q000191:economics*; D007902:Length of Stay; D009853:Omeprazole / Q000191:economics / Q000627:therapeutic use*; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D004791:Enzyme Inhibitors; D009853:Omeprazole