Laparoscopic Nissen fundoplication: technique and preliminary results

ABSTRACT

Laparoscopic Nissen fundoplication is positioned to become the standard of surgical treatment for patients with gastroesophageal reflux disease [GERD]. The present study aimed to evaluate in a prospective manner the technique and the clinical results of laparoscopic Nissen fundoplications. Between Ianuary 1998 and January 2001, 28 patients [17 male and 11 female with a mean age 42 +/- 6.7 years] who had undergone a laparoscopic approach for a Nissen fundoplication in El-Minia University Hospital were studied. All patients had undergone medical treatment for at least 3 months and then were referred to surgery due to unsatisfactory symptom control in 19 patients [67.8%] or to avoid lifelong medications in 9 patients [32.2%]. Laparoscopic Nissen fundoplication was done with or without division of short gastric vessels. It was successful in 24 of 28 patients [85.7%]. The mean operative time was 126 +/- 12.4 minutes. The mean post operative hospital stay was 3.1 + 0.2 days. Conversion from laparoscopic to open fundoplication was needed in 4 cases [14.3%]. There was no operative mortality with low serious morbidity. The mean heartburn score was 2.68 +/- 1.26 before operation versus 0.35 +/- 0.79 after operation by one year, with significant improvement [P<0.01]. The mean preoperative dysphagia score was 1.1 +/- 0.9 versus 0.32 +/- 0.21 by one year postoperatively [P<0.01]. Troublesome dysphagia was reported in 10 patients [35.7%], one was reoperated upon and 9 cases responded to dilatation or diet management