title: Conversions and complications of laparoscopic treatment of gastroesophageal reflux disease.
abstract: BACKGROUND
  Although several authors have documented the safety and efficacy of laparoscopic fundoplication, it is important to determine the rate of conversions and complications of this procedure.
  
  
  METHODS
  We retrospectively reviewed the protocol sheets of 503 consecutive patients with gastroesophageal reflux disease who underwent laparoscopic fundoplication over a period of 5 years. A Nissen-Rosetti procedure was performed in 492 patients (97.8%) and a Toupet procedure in 11 (2.2%). Sixty-four patients were also subjected to a concurrent cholecystectomy, and one patient had a concurrent cervical pharyngoesophageal diverticulectomy with cricopharyngeal myotomy. Thirty-one patients had previous upper abdominal operations.
  
  
  RESULTS
  The period of hospitalization varied from 12 hours to 16 days, with an average of 1.2 days. The operation was converted to an open procedure in 10 patients (2%). The main cause of conversion was the presence of adhesions. The most frequent intraoperative complication was pneumothorax. All pneumothoraces occurred in the first 100 patients. Five patients had significant operative bleeding; two of them required laparotomy for bleeding control. Gastric ulcer was diagnosed in six patients. One alcoholic patient died of acute pancreatitis. Other major complications were two intraabdominal abscesses, one esophageal perforation, one sepsis from gastric perforation, one hemorrhagic shock, and one gastric obstruction from fundoplication herniation.
  
  
  CONCLUSIONS
  Conversions and complications of laparoscopic fundoplication are low and decrease significantly with the surgeon experience, but severe and lethal complications may occur.
authors.affiliation: Department of Surgery of the Hospital NS Graças, Curitiba, Brazil.
authors.forename: J C
authors.initials: JC
authors.lastname: Coelho
authors.forename: J C
authors.initials: JC
authors.lastname: Wiederkehr
authors.forename: A C
authors.initials: AC
authors.lastname: Campos
authors.forename: P C
authors.initials: PC
authors.lastname: Andrigueto
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D018662:Fundoplication / Q000009:adverse effects / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000209:etiology; D012189:Retrospective Studies; D000267:Tissue Adhesions; D017211:Treatment Failure