Goede resultaten op korte en middellange termijn na laparoscopische fundoplicatie volgens Nissen ter behandeling van gastro-oesofageale reflux

Analysis of per- and postoperative complications and functional results in the short and medium-long term following Nissen laparoscopic fundoplication for reflux oesophagitis.

Design

Prospective, descriptive.

Setting

Academic Hospital of the Free University in Amsterdam and Medical Centre Alkmaar, the Netherlands.

Method

Between January 1992 and June 1997 in both hospitals, 50 patients with reflux oesophagitis were operated on laparoscopically and investigated pre- and postoperatively according to a protocol involving scoring of symptoms, endoscopy and pH-measurement; in some of the patients, manometry, gastric emptying studies and an insulin provocation test were also performed.

Results

There was no surgical mortality. Peroperative complications were seen in five patients. Conversion to laparotomic fundoplication was necessary in five patients. Five patients had mild postoperative complications. The mean hospital stay after operation was 5.5 days. Three to six months after discharge 90 of the patients reported the functional results to be good or perfect (n = 100). After a mean follow-up of 48 months this was 97 (n = 30); recurrence was seen in two patients (7). Three patients had to be re-operated for severe dysphagia.

Conclusion

Laparoscopic fundoplication performed by an experienced surgeon is a good technique offering definite advantages to the patient. The short and medium-long term results are good.