Improvement of respiratory symptoms following Laparoscopic Nissen Fundoplication

We report a prospective series of 29 patients who presented for predominantly respiratory symptoms. Typical and respiratory symptoms were graded according to a standard scale. All patients had preoperative investigations confirming GERD. Patients were treated by a standard laparoscopic fundoplication and followed for a minimum of 14 months (range 14 to 48 months). Patients were contacted and interviewed by an independent observer. Conversion to open surgery was necessary in 3 patients. There were 4 significant complications. Ultimately control of typical reflux symptoms was achieved in 88%. Cough was completely relieved in 81% and improved in a further 13%. Wheeze and nocturnal bronchospasm was completely relieved in 50% and improved in the balance. Dysphagia remains a significant problem, with only 42% of patients completely free of trouble. Overall respiratory symptoms were improved in the majority of patients with cough responding somewhat better than wheeze. Careful evaluation of patients remains essential and an algorithm for patient selection will be discussed.