Laparoscopic vs open approach for Nissen fundoplication. A comparative study.

Area of Science:

• Gastroenterology
• Surgical Innovation
• Comparative Effectiveness Research

Background:

• Gastroesophageal reflux disease (GERD) management often involves Nissen fundoplication.
• Previous studies suggest similar outcomes for laparoscopic and open surgical approaches.
• Nonrandomized trials form the basis of much of the existing evidence.

Purpose of the Study:

• To compare the efficacy and safety of laparoscopic versus open Nissen fundoplication.
• To evaluate functional outcomes and complication rates between the two surgical techniques.
• To provide evidence-based guidance for GERD surgical treatment.

Main Methods:

• A randomized controlled trial involving 106 patients with documented GERD.
• Patients were assigned to either laparoscopic or open Nissen fundoplication.
• Preoperative and postoperative assessments included clinical evaluation, esophagogram, endoscopy, manometry, and pH monitoring.

Main Results:

• Both surgical methods effectively controlled GERD symptoms and improved esophageal peristalsis and LES pressure.
• The open approach had significantly higher rates of wound and respiratory complications (p <0.001, p <0.05).
• Postoperative dysphagia rates were similar, but open surgery resulted in more postprandial epigastric fullness and bloating (p <0.05, p <0.01).

Conclusions:

• Laparoscopic and open Nissen fundoplication demonstrate comparable effectiveness in GERD control.
• The open technique is linked to increased surgical site infections, respiratory issues, and early digestive discomfort.
• Dysphagia rates are similar, but laparoscopic surgery may offer advantages in reducing early postoperative gastrointestinal symptoms.