Laparoscopic Nissen Fundoplication Is an Effective Treatment for Gastroesophageal Reflux Disease

Abstract

ObjectiveThe open Nissen fundoplication is effective therapy for gastroesophageal reflux disease. In this study, the outcomes in 198 patients treated with the laparoscopic Nissen fundoplication was evaluated for up to 32 months after surgery to ascertain whether similar positive results could be obtained. Summary Background DataTo ensure surgical success, patients were required to have mechanically defective sphincters on manometry and increased esophageal acid exposure on 24-hour pH monitoring. The patients either had severe complications of gastroesophageal reflux disease or had failed medical therapy. These requirements have been found to be necessary to ensure a successful surgical outcome. MethodsThe disease was complicated by ulceration (46), stricture (25) ResultsPerioperative complications included gastric or esophageal perforation (3), pneumothorax (2), bleeding (2), breakdown of crural repair (2) and periesophageal abscess (1). The only mortality occurred from a duodenal perforation. Six patients required conversion to the open procedure. The median hospital stay was 3 days. One hundred patients were observed for follow-up for 6 to 32 months (median 12 months), with outcomes similar to the open Nissen fundoplication. Further surgery was required for two patients who had recurrent gastroesophageal reflux and one who developed an esophageal stricture. Ninety-seven percent are satisfied with their decision to have the operation. ConclusionsThe laparoscopic Nissen fundoplication can be carried out safely and effectively with similar positive results to the open procedure and with all of the advantages of the minimally invasive approach. 472

Two-year results of a feasibility study on antireflux transoral incisionless fundoplication using EsophyX

“…The study population consisted of patients with advanced stages of chronic GERD who are typically referred for surgery [10,29,30]. The patients had suffered from the disease for more than 10 years and had continuous daily PPI therapy for more than 6 years before undergoing the TIF procedure.…”

“…Patients (n = 14, 50% female) available at 2 years had a median age of 34 (range, 23-55) years and a median BMI of 22 (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31) kg/m 2 . Patients had suffered from GERD for a median of 10 (range, 3-15) years and were on continuous daily PPI therapy for a median of 6 (range, 2-13) years before undergoing TIF.…”

Randomized trial of total fundoplication and fundal mobilization with or without division of short gastric vessels: a short-term clinical evaluation

“…Furthermore, new technical details such as new instruments for a new surgery, learning curve on this new surgical practice, technical diffi culties for the division of the SGV have been discussed. Some publications relating important and long-lasting dysphagia with the non-liberation of the gastric fundus through SGV division 9,22,23 . New techniques were described, as the fundoplication without SGV division to prevent such complication 24 .…”

Quality of Life After Anti-Reflux Surgery in Adults

“…In 1991, Dallemagne described and reported the results of laparoscopic Nissen fundoplication (Dallemagne et al, 1991). Since then, several studies have demonstrated the safety and efficacy of laparoscopic fundoplication (Hallerbäck et al, 1994;Hinder et al, 1994;Hunter et al, 1996;Jamieson et al, 1994;Watson et al, 1996) (Table 3). …”