Laparoscopic nissen's fundoplication: retrospective study of 168 cases, long-term follow-up

Laparoscopic anti-reflux surgery has shown its efficiency since its description by B. Dallemagne in Belgium and T. Geagea in Canada in 1991. As encountered in the laparotomic approach, this technique can be associated with mid- and long-term postoperative side effects.

A retrospective study about 168 patients operated for a gastro-esophageal reflux using the Nissen's technique with division of the short gastric vessels through a laparoscopic approach. There were 73 men (43%) and 95 women (57%) with a median age of 44 years (mean: 54 years, range: 17-82). The patients were seen 10 days, one month and three months postoperatively. After one year, they were seen or contacted by phone. The mean follow-up duration was 19.8 months (median: 12 months, range: 0.33-132).

The mean operation time was 109 minutes (range: 57-210). There was no death. The postoperative morbidity rate was 5%. 142 patients (84%) had a third month control gastroscopy. 123 patients (86.6%) didn't report any complaint related to their reflux after 3 months. After one year, 166 patients (98.8%) were contacted. A reflux recurrence was reported by 4 patients (2.4%), 157 (94.2%) had no complaints. Our results are similar to those found in the literature published about laparoscopic anti-reflux surgery. In our series, we noted less mechanical complications than in the literature. The choice of the technique and the characteristics of our patients could explain this difference.

The laparoscopic total fundoplication with division of the short gastric vessels is, for most of the authors, the first choice technique in the surgical treatment of the gastro-esophageal reflux.