title: Prospective study of laparoscopic nissen fundoplication in a community hospital and its effect on typical, atypical, and nonspecific gastrointestinal symptoms.
abstract: BACKGROUND
  Laparoscopic Nissen fundoplication (LNF) provides long-term improvement in the typical symptoms of gastroesophageal reflux disease. Few studies have prospectively addressed LNF in the community hospital or the effect of LNF on specific atypical symptoms, other related gastrointestinal symptoms, and weight change.
  
  
  METHODS
  Data were collected prospectively on consecutive patients having LNF. Three typical, 6 atypical, and 3 other gastrointestinal symptoms were studied.
  
  
  RESULTS
  Short-term data on 91 patients and long-term data on 84 patients were studied. Overall long-term improvement was 98%. Regarding typical symptoms, the greatest improvement occurred in heartburn and regurgitation. Regarding atypical symptoms, the greatest improvement occurred in cough and sore throat, but chest pain, hoarseness, and throat clearing also showed significant durable improvement. Bloating, nausea, and diarrhea showed no significant change from preoperative to postoperative surveys. Mild weight loss was common.
  
  
  CONCLUSIONS
  LNF can be safely performed in a community hospital with results equal to those of university hospitals. Improvement in typical symptoms was greater than improvement in atypical symptoms, but results for both were significant and durable. Nonspecific gastrointestinal symptoms, such as nausea, bloating, and diarrhea, may be unrelated to Nissen fundoplication.
authors.affiliation: Department of Surgery, New Hanover Regional Medical Center, Wilmington, North Carolina 28402, USA. ransonmark@hotmail.com
authors.forename: Mark E
authors.initials: ME
authors.lastname: Ranson
authors.forename: Amanda
authors.initials: A
authors.lastname: Danielson
authors.forename: J Gary
authors.initials: JG
authors.lastname: Maxwell
authors.forename: James A
authors.initials: JA
authors.lastname: Harris
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000601:surgery*; D006764:Hospitals, Community; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016896:Treatment Outcome