Laparoscopic posterior partial fundoplication: analysis of 100 consecutive cases

Performance of a laparoscopic posterior partial fundoplication (LPPF) for severe gastroesophageal reflux disease may have significant advantages. These include a low incidence of postop dysphagia, maintenance of the ability to belch, excellent antireflux effects, and the ease of performance of the surgery. The purpose of this study was to evaluate this antireflux procedure for these advantages to determine both its safety and effectiveness. Over 200 LPPFs have been performed by the authors in a community setting. One hundred consecutive cases are evaluated for indications, preop, and postop studies (EGD, manometry, 24 h pH), time of operation, hospital stay, complications, and conversions to an open procedure. Our technique of LPPF is presented in detail. All patients maintained the ability to belch. Postop dysphagia resolved totally in 4 patients by 7 days. Four pneumothoraces occurred; 1 patient required bilateral chest tube placement. There were no esophageal, stomach, or splenic injuries. The average hospital stay was 1.6 days. Postop 24 h pH studies revealed resolution of the esophageal reflux. Postop manometric studies show a median increase of 9.2 mm Hg for the LES pressure. No patients have resumed antireflux medication. No short gastric vessels were divided and no esophageal sutures were placed. There were no conversions to a laparotomy. Laparoscopic posterior partial fundoplication is a safe and effective antireflux procedure.