[Use of the harmonic scalpel (Ultracision) in laparoscopic antireflux surgery]

Gastroesophageal reflux disease can effectively be treated by laparoscopic fundoplication. A new multifunctional device has recently been introduced, Ultracision (UC), which can be expected to be especially effective in laparoscopy. Since 9/1995 laparoscopic fundoplication is being performed at our institution. We routinely divide the "short-gastric vessels" and have been using clip-appliers and Endo-GIAs before dividing the vessels with endo-scissors. Since 2/1997 we also use the UC, which applies ultrasonic energy to cause denaturing of proteins and subsequent hemostasis and dissection. This open, non-randomized study compares operative time, intra- and postoperative complications and conversion rates as well as costs of both methods. Between 2/1997 and 12/1997 20 consecutive patients received a floppy Nissen fundoplication by 2 surgeons. In 8 patients clips/EndoGIA were used (m:w = 5:3, mean age 52 years [33-69]), in 12 patients UC (m:W = 10:2, 53 years [25-74]) was used. 2 patients in each group had had previous open abdominal surgery. In the first group 2 procedures had to be converted to open surgery (1 bleeding, 1 anatomical problem), median operative time was 214 min (135-360). In the UC group all procedures were completed laparoscopically, median operative time 132 min (75-240). Postoperative major complication and mortality rates were 0 in both groups. Use of the harmonic scalpel reduced operative time and costs without increasing conversion rates and perioperative complications.