title: Laparoscopic anti-reflux surgery in the community hospital setting: evaluation of 100 consecutive patients.
abstract: BACKGROUND
  Laparoscopic anti-reflux surgery has been shown to be superior to medical management for treatment of complicated gastroesophageal reflux disease (GERD). This study encompasses 100 consecutive patients undergoing laparoscopic Nissen-Rossetti or Toupet fundoplications for GERD refractory to medical management.
  
  
  METHODS
  All 100 patients had failed maximum medical management (behavioral and dietary modifications, antacids, and H2 and acid PUMP blockers). All patients underwent esophagogastroduodenoscopy with biopsy prior to surgery. Ninety-eight patients had esophageal manometry to evaluate the lower esophageal sphincter pressures and determine the amplitude of contractions of the body of the esophagus. Twenty-four hour pH studies were used selectively when the preceding studies were equivocal.
  
  
  RESULTS
  All 100 patients' surgeries were accomplished laparoscopically. The mortality rate was zero. The postoperative complication rate was 2%. The average hospital stay was 1.85 days. Follow-up was achieved in 98%. The mean follow-up was 17.6 months. All patients had significant improvement of their symptoms. No patients have long-term dysphagia.
  
  
  CONCLUSIONS
  The study demonstrates that laparoscopic anti-reflux surgery can be safely and effectively accomplished in the community hospital setting.
authors.forename: R A
authors.initials: RA
authors.lastname: Althar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D018662:Fundoplication / Q000379:methods; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006764:Hospitals, Community; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome