Laparoscopic fundoplication - short- and long-term outcome

Abstract

Gastroesophageal reflux disease is probably the most frequently occurring benign functional disorder in the Western industrial countries. With the increasing popularity of laparoscopic anti-reflux procedures, issues on the appropriate technique have been revitalized. The purpose of this study is to evaluate the short- and long-term outcomes of laparoscopic fundoplication and reflect on the perspective of an increasing frequency of performed operations. The data sampling is based on a literature review and a questionnaire. It can be summarized that reflux recurrence due to breakdown of the wrap or herniation of the wrap can also develop in later years after the primary surgery and amount up to 8%. Persistent dysphagia is a severe problem in the first post-operative year, but usually decreases with time and is limited to rates of 3-5% on the long-term follow-up. Other functional problems, such as gasbloat, meteorism and epigastric pain--the cause often cannot be further detected or specified--limit the quality of life of patients after laparoscopic anti-reflux surgery in the long-term follow-up in up to 5% of cases. Side effects of laparoscopic antireflux procedures can be limited to 5 to 10%, but not totally avoided.

Nationwide survey of long-term results of laparoscopic antireflux surgery in Sweden

“…Our questionnaire was designed to detect medication used specifically to suppress acid reflux symptoms. In some reports, it is not stated how many patients are still on antireflux medication [14][15][16][17][18][19] but, if reported, continuous medical therapy in about 5-20% of patients is usual [20][21][22].…”

Long-term results of antireflux surgery indicate the need for a randomized clinical trial

“…It is assumed that laparoscopic surgery will give at least equal results to open procedures. Many studies report excellent short-term results after laparoscopic antire¯ux surgery 12,13,15,16 , but a fair comparison of laparoscopic and open techniques is dif®cult given the constraints of the nonrandomized research methodology used in almost all of these studies 11,17,18 . To the authors' knowledge the results from only ®ve controlled randomized trials comparing the outcome after the two techniques have been published.…”

“…To equate re¯ux control with success rate may give a false impression 6,7 . The number of patients still on antire¯ux medication 5,10,12,13,16,17 is often not stated but, if reported, continuous medical therapy in about 6±8 per cent is usual 6,11,24 . Even patients with objectively demonstrated anatomical failure of the fundic wrap often do well on PPIs 5 .…”

Prevention of recurrence by reinforcement of hiatal closure using ligamentum teres in laparoscopic repair of large hiatal hernias

“…Despite the excellent clinical outcome following laparoscopic antireflux surgery [1,19], there have been some reports of increasing incidence of complications. Remedial surgery after failed antireflux operation reveals a 22-73% rate of recurrent hiatal hernia as the reason for failure [6,9,11,20].…”