Clinical Evaluation of Laparoscopic Fundoplication for Gastroesophageal Reflux Disease

Hideyuki Kashiwagi, Nobuo Omura, Fumiaki Yano, Yoshio Ishibashi, Nobuyoshi Hanyu and Teruaki Aoki

Department of Surgery, The Jikei University School of Medicine

Background: From August 1994 through September 2000, we retrospectively reviewed 87 patients undergoing laparoscopic fundoplication for gastroesophageal reflux disease (GERD). Our purpose is to evaluate clinical results and complications of laparoscopic fundoplication.
Method: Subjects were 52 men and 35 women aged 18 to 81 (mean age: 52 years). Preoperative assessment included endoscopy, upper gastrointestinal series, and 24-hour pH monitoring. Floppy Nissen fundoplication was conducted in 49 and Collis gastroplasty in 2. Remaining 37 underwent incomplete fundic wrap and highly selective vagotomy together with antireflux surgery in 17.
Results: Mean operating time was 177 minutes (range: 90 to 315), and longer in early cases and obese patients. Perioerative complications included bleeding from the spleen in 5, breakdown of crural repair in 2, esophageal muscle injury in 1, gastric perforation in 1 and pneumothorax in 1 each. No patients required conversion to open procedure. The mean time required for patients to tolerate a full liquid diet was 2.8days (range: 1 to 14), and mean hospital stay of 11.8 days (range: 5 to 60). Further surgery was required for 2 patients who developed persistent dysphagia after Nissen fundoplication and for 1 patient with a relapse of severe gastroesophageal reflux.
Conclusion: Laparoscopic fundoplication for GERD is safe and effective and has all of the advantages of minimal invasiveness.

Key words
gastroesophageal reflux disease, antireflux surgery, laparoscopic fundoplication

Reprint requests
Hideyuki Kashiwagi Department of Surgery, The Jikei University School of Medicine 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461 JAPAN

Accepted
December 19, 2000

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