Risk factors for complications of laparoscopic Nissen fundoplication

Although the rate of complications from laparoscopic Nissen fundoplication is low and the adverse postoperative sequelae are well known, both are disturbing for the patient. Identifying risk factors could be helpful in the better selection of patients for this procedure.

A retrospective review of 126 patients with a mean follow-up period of 3.5 years was conducted. The patients' demographics, pre- and postoperative symptoms, and outcomes were analyzed and compared.

Three groups of patients were distinguished: (group 1) 9 patients with intraoperative complications (5 with perforation, 3 with hemorrhage, 1 with pneumothorax); (group 2) 16 patients with postoperative complications (5 with severe dysphagia, 4 with failure, 2 with pneumonia, 2 with incisional hernia, 1 with intestine perforation, 1 with fundoplication herniation, 1 with infection, 1 with gastric ulcer); and (group 3) 101 patients without any complications. The patients'demographics, preoperative symptoms, and preoperative studies were comparable in all three groups. The body mass index (BMI) was significantly higher (p < 0.05) statistically in group 1 (32.4 kg/m2) and group 2 (33.6 kg/m2) than in group 3 (28.7 kg/m2). However, the Visick grade and the subjective outcome were similarly good in all three groups.

Although preoperative studies and symptoms do not seem to predict complications of laparoscopic Nissen fundoplication, patients with an increased BMI were at increased risk for complications in this study. Therefore, such patients should be counseled appropriately regarding the greater likelihood of intraoperative and postoperative complications.