Laparoscopic Nissen fundoplication: five-year results and beyond.

HYPOTHESIS Laparoscopic Nissen fundoplication provides long-term relief of symptoms of gastroesophageal reflux disease. DESIGN Prospectively evaluated case series. SETTING University teaching hospital. PATIENTS From September 1991 to December 1999, we performed more than 900 laparoscopic antireflux procedures. The outcome for patients who underwent surgery between September 1991 and June 1994 (178 cases) was determined. This included all patients having laparoscopic Nissen fundoplication, from the first procedure onward. INTERVENTIONS Long-term follow-up for 5 or more years after laparoscopic Nissen fundoplication was obtained by an independent investigator who interviewed patients using a structured questionnaire. MAIN OUTCOME MEASURES Prospective evaluation of clinical symptoms using a structured questionnaire. RESULTS Outcome data covering a period of 5 or more years after surgery was available for 176 patients (99%), with 2 patients lost to follow-up. Nine patients died (8 of unrelated causes) at some stage following surgery, and the outcome was difficult to determine in 1 patient with cerebral palsy. Hence, questionnaire data were available for 166 patients at a median follow-up of 6 years (range, 5-8 years). Three patients (1.7%) underwent revision surgery for recurrent reflux; 87% of the 176 patients remained free of significant reflux. Reoperation was required for dysphagia in 7 patients (3.9%), 2 for a tight wrap and 5 for a tight diaphragmatic hiatus. In addition, reoperation was necessary for a paraesophageal hiatus hernia in 13 patients (7.3%). Of the reoperations, 56% were performed within 12 months of the original procedure, and 22% during the second year of follow-up. Further surgery was uncommon after 2 years. The long-term outcome was considered "good or excellent" by 90% of patients. CONCLUSIONS The long-term outcome of laparoscopic Nissen fundoplication is similar to that following open fundoplication. Good results are obtained in most patients.

[1]  D I Watson,et al.  A learning curve for laparoscopic fundoplication. Definable, avoidable, or a waste of time? , 1996, Annals of surgery.

[2]  P. Devitt,et al.  Laparoscopic surgery for gastro‐oesophageal reflux: Beyond the learning curve , 1996, The British journal of surgery.

[3]  G. Jamieson,et al.  Coeliac axis and mesenteric arterial thrombosis following laparoscopic Nissen fundoplication. , 1994, The Australian and New Zealand journal of surgery.

[4]  L. Grande,et al.  Value of Nissen fundoplication in patients with gastro‐oesophageal reflux judged by long‐term symptom control , 1994, The British journal of surgery.

[5]  M. Anvari,et al.  Laparoscopic Nissen fundoplication: two-year comprehensive follow-up of a technique of minimal paraesophageal dissection. , 1998, Annals of surgery.

[6]  P. Devitt,et al.  Stenosis of the esophageal hiatus following laparoscopic fundoplication. , 1995, Archives of surgery.

[7]  L. Nathanson,et al.  Laparoscopic Nissen fundoplication--200 consecutive cases. , 1996, Gut.

[8]  J. Hunter,et al.  Intermediate follow-up of laparoscopic antireflux surgery. , 1996, American journal of surgery.

[9]  H. Gooszen,et al.  Laparoscopic or conventional Nissen fundoplication for gastro-oesophageal reflux disease: randomised clinical trial. The Netherlands Antireflux Surgery Study Group. , 2000, Lancet.

[10]  P. Devitt,et al.  Prospective double-blind randomized trial of laparoscopic Nissen fundoplication with division and without division of short gastric vessels. , 1997, Annals of surgery.

[11]  P. Devitt,et al.  Prospective randomized double‐blind trial between laparoscopic Nissen fundoplication and anterior partial fundoplication , 1999, The British journal of surgery.

[12]  J. Johansson,et al.  Outcome 5 years after 3600° fundoplication for gastro‐oesophageal reflux disease , 1993 .

[13]  L. Lundell,et al.  Long‐term results of a prospective randomized comparison of total fundic wrap (Nissen‐Rossetti) or semifundoplication (Toupet) for gastro‐oesophageal reflux , 1996, The British journal of surgery.

[14]  R. Holloway,et al.  Oesophageal motility before and after laparoscopic Nissen fundoplication , 1997, The British journal of surgery.

[15]  O. Keyriläinen,et al.  Fate of Nissen fundoplication after 20 years. A clinical, endoscopical, and functional analysis. , 1993, Gut.

[16]  M. Anvari,et al.  Laparoscopic Nissen fundoplication is a satisfactory alternative to long‐term omeprazole therapy , 1995, The British journal of surgery.

[17]  J. Hunter,et al.  A physiologic approach to laparoscopic fundoplication for gastroesophageal reflux disease. , 1996, Annals of surgery.

[18]  P. Devitt,et al.  Paraoesophageal hiatus hernia: An important complication of laparoscopic Nissen fundoplication , 1995, The British journal of surgery.

[19]  T. Demeester,et al.  Nissen Fundoplication for Gastroesophageal Reflux Disease: Evaluation of Primary Repair in 100 Consecutive Patients , 1986, Annals of surgery.