✦ LIBER ✦

Changing strategies in the performance of laparoscopic Nissen fundoplication as a result of experience with 230 operations

✍ Scribed by D. I. Watson; G. G. Jamieson; P. G. Devitt; G. Matthew; R. E. Britten-Jones; P. A. Game; R. S. Williams

Publisher: Springer
Year: 1995
Tongue: English
Weight: 553 KB
Volume: 9
Category: Article
ISSN: 0930-2794
DOI: 10.1007/bf00188451

No coin nor oath required. For personal study only.

✦ Synopsis

From September 1991 to January 1995 we performed 230 Nissen fundoplications by a laparoscopic technique. Whilst a loose 360 ° fundoplication secured by 3 or 4 sutures was performed in all instances, there was variation between surgeons regarding the performance of hiatal repair and division of short gastric vessels; 207 operations were completed laparoscopically and 23 were converted to an open operation when a satisfactory wrap could not be achieved. Operating time ranged from 30 to 260 min (median 95) and the median postoperative stay was 3 days (I-19).

Twenty-three patients (10%) underwent a subsequent operation (14 within 3 months of the original surgery), 2 for recurrent reflux, 10 for para-esophageal herniation, 2 for a misplaced fundoplication resulting in gastric obstruction, 7 for persistent dysphagia (4 due to stenosis of the esophageal hiatus), 1 for bleeding, and 1 for mesenteric thrombosis. (This patient died.) Five other patients were readmitted to hospital subsequent to their discharge--four because of pulmonary emboli and one because of gastric obstruction. Some 226 patients (98%) are free of reflux symptoms with follow-up ranging up to 40 months (median 16). Absence of reflux and the integrity of the fundoplication has been confirmed by postoperative esophageal manometry and pH monitoring in 90 patients, and by barium meal in 126.

Postoperative recovery has been quick and woundrelated morbidity minimal. Although the rate of surgical revision was significant in this series, the likelihood of complications or further surgery, as well as incidence of conversion to open surgery, decreased in the second half of the experience. Strategies developed to

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