title: What did the laparoscopic Nissen approach of the gastro-oesophageal reflux really change for the patients 8 years later?
abstract: BACKGROUND
  Nissen fundoplication (NF) is recognized as the surgical treatment of the gastro-oesophageal reflux disease (GERD). NF can be achieved either by open surgery or by laparoscopic approach.
  
  
  METHODS
  From 1987 to 1997, 210 patients were treated for GERD by NF: 61 by open and 149 by laparoscopic approach. All the patients were followed more than 1 year and were scored by clinical assessment (Visick scale adaptation). In case of Visick score > 1, GI-endoscopy, X-ray series or 24-hour pH-study complete the evaluation.
  
  
  RESULTS
  The operative time was comparable between both groups. The postoperative recovery was statistically faster in the laparoscopic group (p = 0.0001). The mean time of follow-up was 6 years after open NF and 4 years after laparoscopic NF. After open NF or laparoscopic NF, 72% and 67% of the patients are respectively scored Visick 1, 13% and 21%--Visick 2, 6.8% and 6%--Visick 3 and 8.2% and 6%--Visick 4 (NS). Patients with recurrence of GERD were scored Visick 4, so failure of the surgical treatment is observed in 5 patients after open NF and 9 patients after laparoscopic NF. The occurrence of incisional hernia was significantly higher in the open group (p = 0.0001).
  
  
  CONCLUSIONS
  NF remains a safe procedure for surgical treatment of GERD and can be achieved by laparoscopic approach with comparable results to those by open laparotomy. In our experience, the advantages of the laparoscopic approach is a faster postoperative recovery and a lower risk of incisional hernia.
authors.affiliation: Medicosurgical Department of Gastroenterology, Erasmus Hospital, Free University of Brussels, Brussels, Belgium.
authors.forename: N
authors.initials: N
authors.lastname: Pelgrims
authors.forename: J
authors.initials: J
authors.lastname: Closset
authors.forename: N
authors.initials: N
authors.lastname: Sperduto
authors.forename: M
authors.initials: M
authors.lastname: Gelin
authors.forename: J J
authors.initials: JJ
authors.lastname: Houben
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000009:adverse effects / Q000191:economics / Q000379:methods* / Q000523:psychology / Q000639:trends; D005764:Gastroesophageal Reflux / Q000145:classification / Q000601:surgery*; D006555:Hernia, Ventral / Q000209:etiology; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics / Q000379:methods* / Q000523:psychology / Q000639:trends; D007813:Laparotomy / Q000009:adverse effects / Q000191:economics / Q000379:methods* / Q000523:psychology / Q000639:trends; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome