Management and outcome of complications after laparoscopic antireflux operations.
OBJECTIVE
Perioperative complications of laparoscopic antireflux operations are infrequent and treatable and do not cause permanent disability.


METHODS
Retrospective review of all patients with laparoscopic antireflux operations for the management and outcome of all complications.


METHODS
University medical center.


METHODS
All 538 patients who underwent operation from January 20, 1993, through December 28, 1999.


METHODS
Complications were defined as any major or minor deviation from the standard postoperative clinical pathway. Minor complications did not require invasive treatment and were not expected to result in permanent disability. Major complications required invasive treatment or could result in permanent disability. The frequency of complications was also stratified into those that occurred during primary antireflux procedures and those that occurred during reoperations for previously failed procedures.


RESULTS
Ninety-two complications occurred in 538 operations (17.1%). Sixty-eight patients (12.6%) experienced minor complications. Postoperative ileus was the most common complication (n = 37 [6.9%]), followed by pneumothorax (n = 13 [2.4%]) and urinary retention (n = 10 [1.9%]). Major complications were present in only 24 patients (4.5%) and occurred significantly more frequently after reoperations. Of these, dysphagia was the most frequent complication observed (n = 11 [2.0%]), followed by perforated viscus (n = 4 [0.7%]). Two patients (0.4%) died. All but 4 major complications resulted in full recovery.


CONCLUSIONS
Major complications in laparoscopic antireflux surgery are rare, their treatment is straightforward, and permanent disability is uncommon. Complications occur twice as often during reoperations, highlighting the difficulty in performing these procedures. Although primary laparoscopic antireflux operations are performed by many general surgeons routinely, reoperations should be performed by a team experienced in laparoscopic esophageal surgery.
Pohl
D
D
Department of Surgery, Campus Box 356410, University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA 98195-6410, USA.
Eubanks
T R
TR
Omelanczuk
P E
PE
Pellegrini
C A
CA
D000328:Adult; D000368:Aged; D004939:Esophageal Perforation / Q000209:etiology; D005260:Female; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006406:Hematoma / Q000209:etiology; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology; D010535:Laparoscopy / Q000009:adverse effects*; D008107:Liver Diseases / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000209:etiology; D012086:Reoperation