[Laparoscopic fundoplication for gastroesophageal reflux: experience with 49 surgical patients (1994-1999)].

Introduction: Chronic gastrooesophageal reflux disease (GERD) is the most common benign pathology of the upper gastrointestinal tract in the western world. We report our experience of laparoscopic antireflux surgery.

Patients and methods: 49 patients underwent laparoscopic antireflux surgery at our clinic between 1994 and 1999. 48 patients were followed up in a retrospective study. Mean follow-up was 30 months (2-66). 31 patients (64.6%) were male and 17 female (35.4%). Mean age was 48 years (26-74). The surgical method was tailored to the case: total Nissen fundoplication (87.5%) was indicated after ruling out oesophageal motility disorders by manometry. In 6 patients (12.5%) with coexisting dysphagia or pathological manometry, partial posterior fundoplication (Toupet) was performed.

Results: Mean operating time of 215 minutes (125-420) for the first 10 Nissens was significantly reduced to 119 minutes (70-190) for the last 10 procedures with increasing experience of the surgeon. No severe intraoperative complications occurred and mortality was 0%. Conversion rate was 4.2%. Mean hospital stay was 6.1 days (1-36). At follow-up 93.7% were free of reflux symptoms without medication, and only one patient (2.1%) suffered from regular reflux which had to be treated with PPI daily. 2 patients (4.2%) took PPI only occasionally. Persistent dysphagia occurred in 7 patients (14.8%). 5 (10.5%) underwent one or more endoscopic dilatations, after which 3 patients (6.3%) reported an improvement of dysphagia. No patient needed reoperation on due to mechanical complications. 1 patient (2.1%) developed a paraoesophageal hernia 4.5 years after a Nissen procedure. According to the Visick Score, 95.8% of all patients were satisfied with their outcome (Visick I/II).

Conclusions: With careful investigation and indication, laparoscopic antireflux surgery is a safe and effective alternative method to long-term medication with PPI in the treatment of gastrooesophageal reflux disease. Morbidity is low. Persistent postoperative dysphagia can be reduced with either a short and floppy total fundoplication or a partial wrap.