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20 years later: laparoscopic fundoplication durability.

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Laparoscopic fundoplication (LF) for gastroesophageal reflux disease (GERD) shows excellent 20-year symptom control in 94% of patients. However, 18% required revision surgery, and dysphagia was common.

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Area of Science:

  • Gastroenterology
  • Minimally Invasive Surgery

Background:

  • Laparoscopic fundoplication (LF) for gastroesophageal reflux disease (GERD) was introduced in 1991.
  • While short-term outcomes are established, long-term patient results require further investigation.

Purpose of the Study:

  • To evaluate the 20-year outcomes of laparoscopic fundoplication (LF) in patients with GERD.
  • To assess long-term symptom control, patient satisfaction, and need for re-intervention.

Main Methods:

  • A cohort of 193 patients undergoing primary LF for GERD (1991-1995) was identified.
  • A validated GERD symptom questionnaire was administered via phone to assess heartburn, regurgitation, and dysphagia.
  • Symptomatic success was defined by absence of re-intervention and low symptom scores.

Main Results:

  • 51 patients (median follow-up 19.7 years) completed the survey.
  • 74.5% reported complete control of heartburn and regurgitation; 94% had occasional or fewer symptoms.
  • 16% reported daily dysphagia, 43% used proton pump inhibitors, and 18% required revision surgery.
  • 90% of patients were satisfied with their surgical choice.

Conclusions:

  • Laparoscopic fundoplication (LF) offers excellent long-term symptom control for GERD.
  • A significant proportion of patients may require revision surgery and experience dysphagia.
  • Despite challenges, the majority of patients report high satisfaction with LF at 20 years.