The Durability of Laparoscopic Nissen Fundoplication: 11-Year Outcomes

Abstract

Laparoscopic Nissen fundoplication (LNF) has become the most commonly performed antireflux procedure since its introduction in 1991. There are few studies with greater than 5-year outcomes. Herein we report a series of 312 consecutive patients who underwent primary LNF before 1996. Follow-up of more than 6 years was available in 166 patients, and the mean follow-up was 11 years (median 11.1 years, range 6.1-13.3 years). Prospective data collection included preoperative and current symptom scores (scale 0 = none to 3 = severe), as well as the level of patient satisfaction and use of antireflux medications. Total symptom score for each patient was summed from seven symptoms for a maximum value of 21. Heartburn and regurgitation were the most improved symptoms; however, all symptoms were significantly improved (P < 0.01). The total symptom score at follow-up was 2.6 down from 7.5 at baseline, with a mean difference of -4.9 (range -12 to 3). The percentage of patients stating they would have the procedure again was 93.3%, and 70% were off daily antireflux medications. Outcomes at a mean of 11 years after LNF are excellent, and the majority of patients had their symptoms resolved or significantly improved and are satisfied with their results.

Who will fail laparoscopic Nissen fundoplication? Preoperative prediction of long-term outcomes

“…In our previously published series of 166 patients after LNF with a mean duration of follow-up of 11 years, 93.3% of patients would do the operation again and 92.5% were satisfied or very satisfied with their results. Heartburn improved in 90% of patients and 65% were completely cured of this symptom [6]. Other series with long term follow-up have confirmed that LNF is the gold standard for the treatment of severe GERD [7,8].…”

“…Recent follow-up was obtained from 166 patients at a mean of 11.0 ± 1.2 years (median 11.1 years, range 6.1-13.3 years) [6]. Eight additional patients known to have undergone reoperation were lost to follow-up but are included in this analysis in the failure group.…”

Hiatal Hernia, Lower Esophageal Sphincter Incompetence, and Effectiveness of Nissen Fundoplication in the Spectrum of Gastroesophageal Reflux Disease

“…8 Numerous studies have shown that patients with ERD or BE are effectively treated by antireflux surgery, with safe, long-term control of reflux symptoms, normalization of esophageal acid and nonacid exposure, and a significant improvement in quality of life. [10][11][12][13][14] Few data, in contrast, are available on the results of surgical therapy for all stages of the GERD spectrum including NERD. 13,15 The results of surgical treatment are especially important for patients with NERD as medical treatments are widely reported as being less effective for these patients.…”

Ten-year results of a randomized clinical trial of laparoscopic total fundoplication with or without division of the short gastric vessels

“…It may sometimes be necessary to divide some of the short gastric vessels in order to construct a tension-free wrap, but this cannot be recommended in routine surgical practice. The degree of mechanical difficulty after total fundoplication varies in different reports 4,5,17,19 . In the present study just over 80 per cent of patients reported no dysphagia at all, although only a minority had severe complaints.…”