ORLANDO — Laparoscopic Nissen fundoplication is a feasible option for some patients with medically refractory gastroesophageal reflux disease, Dr. Ignazio M. Civello said at a meeting on laparoscopy and minimally invasive surgery sponsored by the Society of Laparoendoscopic Surgeons.
“We used to do this procedure much more often than we do now,” said Dr. Civello, director of surgery at the Università Cattolica del Sacro Cuore Policlinico Gemelli, Rome. “But it still may be an option for patients who experience symptoms despite adequate medical therapy or for those who don't wish to embark on long-term medication.”
He presented a 5-year case series of 150 patients (mean age 55 years) who underwent the surgery. All of them had gastroesophageal reflux symptoms, including heartburn (95 patients), dysphagia (62), epigastric pain (65), and chest pain (35).
Preoperatively, all of the patients underwent barium x-ray, endoscopy, esophageal motility testing, and 24-hour pH monitoring, Dr. Civello said.
Of the 150 patients, 147 had severe acid reflux on pH monitoring. Endoscopic evidence of esophagitis was seen in 68, and 55 also had hiatal hernia with defective lower esophageal sphincter.
The entire group underwent laparoscopic Nissen fundoplication with no division of the short gastric vessels, and a concomitant crural repair.
The mean operative time was 90 minutes. There were two conversions: one because of splenic injuries that were not repairable by laparoscopy, and one caused by a large gastric fundus perforation during the flap construction maneuver.
The average hospital stay was 3 days. There was no postoperative morbidity or mortality. Follow-up of 6–18 months was available for 135 patients.
The outcomes were assessed by using a structured questionnaire and repeat 24-hour pH monitoring.
All of the patients had resolution of their acid reflux. Functional results were excellent in 85%, good in 10%, fair in 3%, and poor in 2%.
Persistent dysphagia occurred in 15 patients, and 20 had gas and bloating—a transient postoperative phenomenon that usually resolves within 12 months of surgery, Dr. Civello said.