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Laparoscopic antireflux surgery: five-year results and beyond in 1340 patients
Patrick Pessaux1, Jean-Pierre Arnaud, Jean-François Delattre
1Department of Digestive Surgery, University Hospital, CHU Angers, 4 Rue Larrey, 49033 Angers Cedex 01, France.
Background:
Although the long-term results of open fundoplication for gastroesophageal reflux disease are well documented, few reports exist on the long-term results of laparoscopic fundoplication.
Design:
Retrospective study with clinical evaluation or mailed survey for patients unable to return to the hospital center.
Setting:
Multicenter studies (ie, private medical centers, institutional hospitals, and university hospitals).
Patients:
Between January 1992 and December 1998, 2684 patients with gastroesophageal reflux disease underwent laparoscopic fundoplication in 31 hospital centers. Outcome data covering a period of 5 or more years after surgery were available for 1340 patients: 711 who underwent complete fundoplication, 559 who underwent partial posterior fundoplication, and 70 who underwent partial anterior fundoplication.
Main Outcome Measures:
Evaluation of clinical and quality-of-life actions used to treat the symptoms of gastroesophageal reflux disease.
Results:
The overall residual severe dysphagia rate was 5.1% (n = 68). A further surgical procedure was required for 59 patients (4.4%) for a total of 63 interventions. Subsequent operation was performed laparoscopically in 32 cases (50.8%). Twelve of these procedures were for the repair of a paraesophageal hiatus hernia, 11 were for dysphagia (4 because of a tight esophageal hiatus and 7 for conversion of Nissen fundoplication to a posterior partial fundoplication procedure), 31 were for recurrent reflux (wrap undone), 2 were for intestinal obstruction (adhesiolysis), 1 was for incisional hernia, 1 was for abdominal abscess (drainage), and 1 was for gastroparesis (pyloroplasty). The recurrence rate was 10.1% (n = 136), and 122 patients (9.1%) resumed taking antisecretory medication. Gas bloat syndrome was present in 101 patients (7.5%). A total of 93.1% of the patients were satisfied (Visick classification, grades 1 and 2) and 6.9% were unsatisfied, with no difference among the 3 procedures.
Conclusion:
After 5 years of experience, laparoscopic fundoplication remains an effective antireflux procedure.
