Five- to eight-year outcome of the first laparoscopic Nissen fundoplications

The operative mortality and morbidity: of laparoscopic fundoplication are lower than fur the open procedure. Questions have been raised regarding its long-term durability One hundred seventy-one pa tit nts who had undergone laparoscopic Nissen fundoplication at least 5 years previously answered a questionnaire. During this period, 291 patients underwent a laparoscopic Nissen fundoplication. Surveillance data were available fur 171 patients at a mean of 6.4 years after surgery. Overall, 96.5% were satisfied and 3.5% were not satisfied with tile result of the procedure. Persistent symptoms included abdominal bloating (20.5%), diarrhea (12.3%), regurgitation (6.4%), heartburn (5.8%) and chest pain ( 4.1%); 27.5% reported dysphagia, and 7% had required dilatation. Fourteen percent were on continuous proton pump, inhibitor therapy; but 79% of these patients were treated for vague abdominal or chest symptoms unrelated to reflux, which calls into question the indications fur this therapy. Ninety-three percent of all patient were satisfied with their decision to have surgery The overall well-being score increased significantly from 2.2 +/- 1.6 before surgery to 8.8 +/- 2 (P >0.0001) at more than 5 years after surgery Twenty-one percent had undergone additional diagnostic procedures after surgery such as endoscopy and/or barium swallow Laparoscopic Nissen fundoplication is an excellent long-term treatment for gastroesophageal reflux disease with persistent success for more than 5 years. Some patients: have continuing symptoms and remain on therapy, but more than 90% of all patients undergoing laparoscopic Nissen fundoplication remain satisfied with their decision to have surgery These results are at least as good as those achieved with open fundoplication and prove the long-term worth of this procedure.