Laparoscopic Nissen-Rossetti fundoplication. First results

From January 1992 to July 1994, 148 patients with symptomatic gastroesophageal reflux and/or hiatal hernia underwent Nissen-Rossetti fundoplication by a laparoscopic approach. There was no conversion and no postoperative death. The main intraoperative complications were hemorrhage (n = 12), pleural opening (n = 5), and gastric perforation (seromuscular effraction) (n = 1). Laparoscopic reoperation was necessary in two patients as a result of bleeding, and there were two cases of food impaction. The median hospital stay was 4.9 days; 117 patients were observed for follow-up for 3-31 months (median 6.2 months). Eleven cases of dysphagia extending beyond 2 months have been observed. In five of those cases, endoscopic dilatation provided effective treatment of dysphagia and in four others, a further laparoscopic intervention enabled a cure to be obtained. Eighty-four percent are satisfied with their decision to have the operation. The laparoscopic Nissen-Rossetti fundoplication can be carried out safely and effectively with positive results similar to those obtained with the open procedure and with all of the advantages of the minimally invasive approach.