Laparoscopic antireflux surgery: five-year results and beyond in 1340 patients.
BACKGROUND
Although the long-term results of open fundoplication for gastroesophageal reflux disease are well documented, few reports exist on the long-term results of laparoscopic fundoplication.


METHODS
Retrospective study with clinical evaluation or mailed survey for patients unable to return to the hospital center.


METHODS
Multicenter studies (ie, private medical centers, institutional hospitals, and university hospitals).


METHODS
Between January 1992 and December 1998, 2684 patients with gastroesophageal reflux disease underwent laparoscopic fundoplication in 31 hospital centers. Outcome data covering a period of 5 or more years after surgery were available for 1340 patients: 711 who underwent complete fundoplication, 559 who underwent partial posterior fundoplication, and 70 who underwent partial anterior fundoplication.


METHODS
Evaluation of clinical and quality-of-life actions used to treat the symptoms of gastroesophageal reflux disease.


RESULTS
The overall residual severe dysphagia rate was 5.1% (n = 68). A further surgical procedure was required for 59 patients (4.4%) for a total of 63 interventions. Subsequent operation was performed laparoscopically in 32 cases (50.8%). Twelve of these procedures were for the repair of a paraesophageal hiatus hernia, 11 were for dysphagia (4 because of a tight esophageal hiatus and 7 for conversion of Nissen fundoplication to a posterior partial fundoplication procedure), 31 were for recurrent reflux (wrap undone), 2 were for intestinal obstruction (adhesiolysis), 1 was for incisional hernia, 1 was for abdominal abscess (drainage), and 1 was for gastroparesis (pyloroplasty). The recurrence rate was 10.1% (n = 136), and 122 patients (9.1%) resumed taking antisecretory medication. Gas bloat syndrome was present in 101 patients (7.5%). A total of 93.1% of the patients were satisfied (Visick classification, grades 1 and 2) and 6.9% were unsatisfied, with no difference among the 3 procedures.


CONCLUSIONS
After 5 years of experience, laparoscopic fundoplication remains an effective antireflux procedure.
Pessaux
Patrick
P
Department of Digestive Surgery, University Hospital, CHU Angers, 4 Rue Larrey, 49033 Angers Cedex 01, France.
Arnaud
Jean-Pierre
JP
Delattre
Jean-François
JF
Meyer
Christian
C
Baulieux
Jacques
J
Mosnier
Henri
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome