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Laparoscopic Nissen fundoplication: laparoscopic dissection technique and results
G B Cadiere1, J Himpens, A Rajan
1Department of Gastro-Intestinal Surgery, C.H.U. Saint-Pierre, Brussels, Belgium.
Hepato-Gastroenterology
|January 1, 1997
Summary
Laparoscopic Nissen fundoplication (LNF) offers an effective surgical option for gastroesophageal reflux disease, providing significant symptom relief and improved esophageal function compared to long-term medical management.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Reflux Disease Management
Background:
- Proton Pump Inhibitors (PPIs) and laparoscopic surgery have revolutionized GERD therapy.
- Newer techniques introduce unique treatment-associated complications.
- This study evaluates laparoscopic Nissen fundoplication (LNF) against long-term PPI use.
Purpose of the Study:
- To compare the efficacy and outcomes of LNF versus PPIs for GERD.
- To assess the safety and complication profile of LNF.
- To evaluate functional outcomes such as LES pressure and reflux time.
Main Methods:
- A prospective study of 224 patients undergoing LNF between 1991 and 1996.
- Patients had varying stages of esophagitis, including Barrett's esophagus.
- Standardized 5-trocar technique with a 5 cm fundic wrap was employed.
Main Results:
- Median operative time was 60 minutes with a low rate of perioperative complications (5).
- Early complications included pulmonary infections and surgical issues (wrap necrosis, bowel perforation).
- Post-operative outcomes showed normal esophageal findings in most patients, improved LES pressure, reduced reflux time, and high Visick I scores (130/154).
Conclusions:
- Laparoscopic Nissen fundoplication (LNF) presents a compelling surgical alternative to long-term PPI therapy for GERD.
- LNF demonstrates favorable functional outcomes and acceptable complication rates.
- The procedure offers significant long-term relief for patients with gastroesophageal reflux disease.