Laparoscopic antireflux surgery - Experience and outcomes

The availability of laparoscopic antireflux surgery for gastroesophageal reflux disease (GERD) has shown this technique to be safe and well tolerated. In large series of patients the technique has proven its value with good short-term results. During the period 1991-1996 we performed 595 laparoscopic antireflux procedures in patients with GERD after careful preoperative testing to identify suitable surgical candidates. The disease was complicated by large paraesophageal hernia (61), strictures (62), Barrett's esophagus (92), ulceration (111), and pulmonary symptoms (174). Patients underwent a standard floppy Nissen fundoplication, or in the case of weak esophageal body function a partial fundoplication was performed. Patients were observed by a shortterm and a long-term follow-up. Perioperative complications included bleeding (19), gastric, duodenal or esophageal perforation (13), pneumothorax (4), pulmonary and urinary infection (2), breakdown of the crural repair (2), subphrenic abscess (1), and vagal nerve injury (1). One patient had a delayed duodenal perforation with subsequent adult respiratory distress syndrome (ARDS) causing death. Redo surgery was necessary in 4 cases with crural disruption (2), a slipped (1) and a too tight wrap (1). Some patients required a single dilatation, and 5 patients with severe dysphagia required multiple dilatations. No splenic injuries occurred. The median postoperative stay was 2 days, and the median time for return to work was 2 weeks. The clinical outcome showed a 97% satisfaction rate. Laparoscopic antireflux surgery has shown to be very effective in the management of GERD in selected patients. It has an excellent shortterm clinical outcome with lower morbidity and mortality than is the case with the open approach. Long-term results are expected to equal those of the open procedure. Laparoscopic antireflux surgery seems to be more cost-effective than long-term medication.