title: [Laparoscopic Nissen fundoplication: results and prognostic factors].
abstract: BACKGROUND
  Laparoscopic Nissen fundoplication is the technique of choice in the surgical treatment of gastroesophageal reflux disease.
  
  
  OBJECTIVE
  To review the cases of laparoscopic Nissen fundoplication carried out at our hospital and to analyze the prognostic factors that influenced surgical outcome.
  
  
  METHODS
  A total of 226 patients that underwent laparoscopic Nissen fundoplication within the time frame of 1996 to 2010 were retrospectively reviewed. Surgical results and prognostic factors were evaluated in 182 patients that had a follow-up longer than one year.
  
  
  RESULTS
  The Nissen-Rossetti technique was carried out in 219 patients, without short gastric vessel division, and the "floppy"-Nissen technique was performed on seven patients. Intraoperative complication rate was 3.1%, conversion rate was 6.6%, and postoperative complication rate was 4%. Mortality was 0. After surgery, 19% of patients presented with dysphagia that was persistent in only 3.5%. Of the 182 patients with a follow-up longer than one year, 166 (91.2%) were satisfied with the surgical results. In the univariate analysis, esophagitis (OR=0.59) was a protective factor, while a DeMeester score >50 (OR=1.97) and medical treatment resistance (OR=1.75) were risk factors. In the multivariate analysis a DeMeester score >50 (OR=4.24) was the only independent prognostic factor associated with poor outcome.
  
  
  CONCLUSIONS
  Our results with laparoscopic Nissen fundoplication are comparable to those found in the medical literature, with a high degree of patient satisfaction. Esophagitis is associated with good outcome, while massive reflux and medical treatment resistance are negative prognostic factors.
authors.affiliation: Adjunto del Servicio de Cirugía General y Aparato Digestivo Complejo Asistencial Universitario de Burgos, Burgos, España. gregoriomoral@ono.com
authors.forename: M G I
authors.initials: MG
authors.lastname: Moral
authors.forename: P J F
authors.initials: PJ
authors.lastname: Reoyo
authors.forename: M R
authors.initials: MR
authors.lastname: León
authors.forename: L A
authors.initials: LA
authors.lastname: Palomo
authors.forename: S S
authors.initials: SS
authors.lastname: Rodríguez
authors.forename: G J L
authors.initials: GJ
authors.lastname: Seco
mesh_terms: D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D011795:Surveys and Questionnaires