[Retrospective study between open vs. laparoscopic funduplication in gastroesophageal reflux disease]

Nissen funduplication is each time more frequently used for gastroesophageal reflux disease (GERD) treatment. Surgical technique has changed from open to laparoscopic.

To analyze in comparative form the results of open and laparoscopic Nissen procedure.

In a period of five years, Nissen funduplication was practiced to 144 patients with confirmed GERD (50 open and 94 laparoscopic). All the patients were follow-up in Outpatient Consultation of the hospital for a minimum period of a year, evaluating in comparative form results and complications of the intervention. Retrospective revision of the files was made.

Surgical time average in open surgeries was of 2.6 hours, and laparoscopic 2.57 hours (p = ns). Splenectomy in a patient operated in open form was an only complication. Postoperating complications in four patients (5%) laparoscopic and in 10 (20%) open (p 0.002). Hospital stay in these last ones was of 7.6 days and in laparoscopic 4.7 days (p < 0.0001). A year after the intervention, 19 patients (38%) open surgeries presented suggestive symptoms of reflux or had proton pump inhibitors (PPIs). Of these, in 5 (10%) recurrence of the GERD by some method was confirmed requiring reoperation two of them. In five peptic acid gastro/duodenal disease was confirmed and the rest had drugs without specific indication, demonstrating suitable morphology of the SEGD intervention. In the laparoscopic group, there were 26 symptomatic patients or who had PPIs a year after the intervention (27%). In seven (7%) reflux recurrence was confirmed, becoming necessary the reintervention in two. Another gastric/duodenal pathology in 13 was documented and six had drugs without specific indication.

Nissen operation allows reflux control in 90% of the patients. Laparoscopic intervention requires a smaller hospital stay and is associated to less frequency of complications. The accomplishment of all technical steps of Nissen surgery, open or laparoscopic, is indispensable for good results.