Clinical results of laparoscopic fundoplication at ten years after surgery

  • B. DallemagneEmail author
  • J. Weerts
  • S. Markiewicz
  • J.-M. Dewandre
  • C. Wahlen
  • B. Monami
  • C. Jehaes



Several studies have demonstrated laparoscopic antireflux surgery (LAS) for the treatment of gastroesophageal reflux disease (GERD) to be efficient at short- and midterm follow-up evaluations. The aim of this study was to evaluate the results for LAS 10 years after surgery.


The 100 consecutive patients who underwent LAS by a single surgeon in 1993 were entered into a prospective database. Nissen fundoplication was performed for 68 patients, and partial posterior fundoplication (modified Toupet procedure) was performed for 32 patients. Evaluations of the outcome were made 5 and 10 years after surgery. A structured symptom questionnaire and upper gastrointestinal barium series were used at 5 years. The same questionnaire and an added quality-of-life questionnaire (the Gastrointestinal Quality of Life Index [GIQLI]) were used at 10 years.


Seven patients died of unrelated causes during the 10-year period. Four patients underwent revision surgery: one patient for persistent dysphagia and three patients for recurrent reflux symptoms. Three patients were lost to any follow-up study. At 5 years, 93% of the patients were free of significant reflux symptoms. At 10 years, 89.5% of the patients still were free of significant reflux (93.3% after Nissen, 81.8% after Toupet). Major side effects (flatulence and abdominal distension) were related to “wind” problems. The GIQLI scores at 10 years were significantly better than the preoperative scores of the patients under medical therapy with proton pump inhibitors.


Elimination of GERD symptoms improved quality of life and eliminated the need for daily acid suppression in most patients. These results, apparent 5 years after the operation, still were valid at 10 years.


Gastroesophageal reflux disease (GERD) Laparoscopic antireflux surgery (LAS) Nissen fundoplication Toupet procedure 


  1. 1.
    Dallemagne B, Weerts JM, Jeahes C, Markiewicz S (1998) Results of laparoscopic Nissen fundoplication. Hepatogastroenterology 45: 1338–1343PubMedGoogle Scholar
  2. 2.
    Spechler SJ, Lee E, Ahnen D, Goyal RK, Hirano I, Ramirez F, Raufman JP, Sampliner R, Schnell T, Sontag S, Vlahcevic ZR, Young R, Williford W (2001) Long-term outcome of medical and surgical therapies for gastroesophageal reflux disease: follow-up of a randomized controlled trial. JAMA 285: 2331–2338PubMedCrossRefGoogle Scholar
  3. 3.
    Eypasch E, Williams JI, Wood-Dauphinee S, Ure BM, Schmulling C, Neugebauer E, Troidl H (1995) Gastrointestinal Quality of Life Index: development, validation, and application of a new instrument. Br J Surg 82: 216–222PubMedGoogle Scholar
  4. 4.
    Korolija D, Sauerland S, Wood-Dauphinee S, Abbou CC, Eypasch E, Caballero MG, Lumsden MA, Millat B, Monson JR, Nilsson G, Pointner R, Schwenk W, Shamiyeh A, Szold A, Targarona E, Ure B, Neugebauer E (2004) Evaluation of quality of life after laparoscopic surgery: evidence-based guidelines of the European Association for Endoscopic Surgery. Surg Endosc 18: 879–897PubMedCrossRefGoogle Scholar
  5. 5.
    Granderath FA, Kamolz T, Schweiger UM, Pointner R (2002) Long-term follow-up after laparoscopic refundoplication for failed antireflux surgery: quality of life, symptomatic outcome, and patient satisfaction. J Gastrointest Surg 6: 812–818PubMedCrossRefGoogle Scholar
  6. 6.
    Lochegnies A, Hauters P, Janssen P, Nakad A, Farchack E, Defrennes M (2001) Quality-of-life assessment after Nissen fundoplication. Acta Chir Belg 101: 20–24PubMedGoogle Scholar
  7. 7.
    Slim K, Bousquet J, Kwiatkowski F, Lescure G, Pezet D, Chipponi J (2000) Quality of life before and after laparoscopic fundoplication. Am J Surg 180: 41–45PubMedCrossRefGoogle Scholar
  8. 8.
    Capelluto E, Barrat C, Catheline JM, Champault G (2001) Quality of life one year after laparoscopic fundoplication is close to that of a control group: prospective study (French). Ann Chir 126: 440–444PubMedCrossRefGoogle Scholar
  9. 9.
    DeMeester TR, Bonavina L, Albertucci M (1986) Nissen fundoplication for gastroesophageal reflux disease: evaluation of primary repair in 100 consecutive patients. Ann Surg 204: 9–20PubMedGoogle Scholar
  10. 10.
    Grande L, Toledo-Pimentel V, Manterola C, Lacima G, Ros E, Garcia-Valdecasas JC, Fuster J, Visa J, Pera C (1994) Value of Nissen fundoplication in patients with gastro-oesophageal reflux judged by long-term symptom control. Br J Surg 81: 548–550PubMedGoogle Scholar
  11. 11.
    Lundell L, Miettinen P, Myrvold HE, Pedersen SA, Liedman B, Hatlebakk JG, Julkonen R, Levander K, Carlsson J, Lamm M, Wiklund I (2001) Continued (5-year) follow-up of a randomized clinical study comparing antireflux surgery and omeprazole in gastroesophageal reflux disease. J Am Coll Surg 192: 172–179PubMedCrossRefGoogle Scholar
  12. 12.
    Luostarinen M (1993) Nissen fundoplication for reflux esophagitis: long-term clinical and endoscopic results in 109 of 127 consecutive patients. Ann Surg 217: 329–337PubMedGoogle Scholar
  13. 13.
    Anvari M, Allen C (1998) Laparoscopic Nissen fundoplication: two-year comprehensive follow-up of a technique of minimal paraesophageal dissection. Ann Surg 227: 25–32PubMedCrossRefGoogle Scholar
  14. 14.
    Hinder RA, Filipi CJ, Wetscher G, Neary P, DeMeester TR, Perdikis G (1994) Laparoscopic Nissen fundoplication is an effective treatment for gastroesophageal reflux disease. Ann Surg 220: 472–481PubMedGoogle Scholar
  15. 15.
    Hunter JG, Trus TL, Branum GD, Waring JP, Wood WC (1996) A physiologic approach to laparoscopic fundoplication for gastroesophageal reflux disease. Ann Surg 223: 673–685PubMedCrossRefGoogle Scholar
  16. 16.
    Kamolz T, Granderath FA, Bammer T, Wykypiel H Jr, Pointner R (2002) Floppy’ Nissen vs Toupet laparoscopic fundoplication: quality-of-life assessment in a 5-year follow-up (part 2). Endoscopy 34: 917–922PubMedCrossRefGoogle Scholar
  17. 17.
    Landreneau RJ, Wiechmann RJ, Hazelrigg SR, Santucci TS, Boley TM, Magee MJ, Naunheim KS (1998) Success of laparoscopic fundoplication for gastroesophageal reflux disease. Ann Thorac Surg 66: 1886–1893PubMedCrossRefGoogle Scholar
  18. 18.
    Patti MG, Feo CV, De Pinto M, Arcerito M, Tong J, Gantert W, Tyrrell D, Way LW (1998) Results of laparoscopic antireflux surgery for dysphagia and gastroesophageal reflux disease. Am J Surg 176: 564–568PubMedCrossRefGoogle Scholar
  19. 19.
    Peters JH, DeMeester TR, Crookes P, Oberg S, de Vos SM, Hagen JA, Bremner CG (1998) The treatment of gastroesophageal reflux disease with laparoscopic Nissen fundoplication: prospective evaluation of 100 patients with ‘typical’ symptoms. Ann Surg 228: 40–50PubMedCrossRefGoogle Scholar
  20. 20.
    Watson DI, Jamieson GG (1998) Antireflux surgery in the laparoscopic era. Br J Surg 85: 1173–1184PubMedCrossRefGoogle Scholar
  21. 21.
    Weerts JM, Dallemagne B, Hamoir E, Demarche M, Markiewicz S, Jehaes C, Lombard R, Demoulin JC, Etienne M, Ferron PE (1993) Laparoscopic Nissen fundoplication: detailed analysis of 132 patients. Surg Laparosc Endosc 3: 359–364PubMedGoogle Scholar
  22. 22.
    Peters JH, Heimbucher J, Kauer WK, Incarbone R, Bremner CG, DeMeester TR (1995) Clinical and physiologic comparison of laparoscopic and open Nissen fundoplication. J Am Coll Surg 180: 385–393PubMedGoogle Scholar
  23. 23.
    Blomqvist A, Lonroth H, Dalenback J, Ruth M, Wiklund I, Lundell L (1996) Quality-of-life assessment after laparoscopic and open fundoplications: results of a prospective, clinical study. Scand J Gastroenterol 31: 1052–1058PubMedGoogle Scholar
  24. 24.
    Rantanen TK, Salo JA, Salminen JT, Kellokumpu IH (1999) Functional outcome after laparoscopic or open Nissen fundoplication: a follow-up study. Arch Surg 134: 240–244PubMedCrossRefGoogle Scholar
  25. 25.
    Velanovich V (1999) Comparison of symptomatic and quality-of-life outcomes of laparoscopic versus open antireflux surgery. Surgery 126: 782–788PubMedGoogle Scholar
  26. 26.
    Heikkinen TJ, Haukipuro K, Bringman S, Ramel S, Sorasto A, Hulkko A (2000) Comparison of laparoscopic and open Nissen fundoplication 2 years after operation: a prospective randomized trial. Surg Endosc 14: 1019–1023PubMedCrossRefGoogle Scholar
  27. 27.
    Dallemagne B, Weerts JM, Jehaes C, Markiewicz S (1996) Causes of failures of laparoscopic antireflux operations. Surg Endosc 10: 305–310PubMedCrossRefGoogle Scholar
  28. 28.
    Hunter JG, Smith CD, Branum GD, Waring JP, Trus TL, Cornwell M, Galloway K (1999) Laparoscopic fundoplication failures: patterns of failure and response to fundoplication revision. Ann Surg 230: 595–604PubMedCrossRefGoogle Scholar
  29. 29.
    Soper NJ, Dunnegan D (1999) Anatomic fundoplication failure after laparoscopic antireflux surgery. Ann Surg 229: 669–676PubMedCrossRefGoogle Scholar
  30. 30.
    Watson DI, Jamieson GG, Devitt PG, Mitchell PC, Game PA (1995) Paraoesophageal hiatus hernia: an important complication of laparoscopic Nissen fundoplication. Br J Surg 82: 521–523PubMedGoogle Scholar
  31. 31.
    Deschamps C, Allen MS, Trastek VF, Johnson JO, Pairolero PC (1998) Early experience and learning curve associated with laparoscopic Nissen fundoplication. J Thorac Cardiovasc Surg 115: 281–284PubMedCrossRefGoogle Scholar
  32. 32.
    Voitk A, Joffe J, Alvarez C, Rosenthal G (1999) Factors contributing to laparoscopic failure during the learning curve for laparoscopic Nissen fundoplication in a community hospital. J Laparoendosc Adv Surg Tech A 9: 243–248PubMedCrossRefGoogle Scholar
  33. 33.
    Watson DI, Jamieson GG, Baigrie RJ, Mathew G, Devitt PG, Game PA, Britten-Jones R (1996) Laparoscopic surgery for gastro-oesophageal reflux: beyond the learning curve. Br J Surg 83: 1284–1287PubMedCrossRefGoogle Scholar
  34. 34.
    Anvari M, Allen C (2003) Five-year comprehensive outcomes evaluation in 181 patients after laparoscopic Nissen fundoplication. J Am Coll Surg 196: 51–57PubMedCrossRefGoogle Scholar
  35. 35.
    Bammer T, Hinder RA, Klaus A, Klingler PJ (2001) Five- to eight-year outcome of the first laparoscopic Nissen fundoplications. J Gastrointest Surg 5: 42–48PubMedCrossRefGoogle Scholar
  36. 36.
    Booth MI, Jones L, Stratford J, Dehn TC (2002) Results of laparoscopic Nissen fundoplication at 2–8 years after surgery. Br J Surg 89: 476–481PubMedCrossRefGoogle Scholar
  37. 37.
    Lafullarde T, Watson DI, Jamieson GG, Myers JC, Game PA, Devitt PG (2001) Laparoscopic Nissen fundoplication: five-year results and beyond. Arch Surg 136: 180–184PubMedCrossRefGoogle Scholar
  38. 38.
    Nilsson G, Wenner J, Larsson S, Johnsson F (2004) Randomized clinical trial of laparoscopic versus open fundoplication for gastro-oesophageal reflux. Br J Surg 91: 552–559PubMedCrossRefGoogle Scholar
  39. 39.
    Donkervoort SC, Bais JE, Rijnhart-de Jong H, Gooszen HG (2003) Impact of anatomical wrap position on the outcome of Nissen fundoplication. Br J Surg 90: 854–859PubMedCrossRefGoogle Scholar
  40. 40.
    O’Boyle CJ, Watson DI, Jamieson GG, Myers JC, Game PA, Devitt PG (2002) Division of short gastric vessels at laparoscopic Nissen fundoplication: a prospective double-blind randomized trial with 5-year follow-up. Ann Surg 235: 165–170PubMedCrossRefGoogle Scholar
  41. 41.
    Luostarinen ME, Koskinen MO, Isolauri JO (1996) Effect of fundal mobilisation in Nissen–Rossetti fundoplication on oesophageal transit and dysphagia: a prospective, randomised trial. Eur J Surg 162: 37–42PubMedGoogle Scholar
  42. 42.
    Chrysos E, Tzortzinis A, Tsiaoussis J, Athanasakis H, Vasssilakis J, Xynos E (2001) Prospective randomized trial comparing Nissen to Nissen–Rossetti technique for laparoscopic fundoplication. Am J Surg 182: 215–221PubMedCrossRefGoogle Scholar
  43. 43.
    Luostarinen ME, Isolauri JO (1999) Randomized trial to study the effect of fundic mobilization on long-term results of Nissen fundoplication. Br J Surg 86: 614–618PubMedCrossRefGoogle Scholar
  44. 44.
    Watson DI, Pike GK, Baigrie RJ, Mathew G, Devitt PG, Britten-Jones R, Jamieson GG (1997) Prospective double-blind randomized trial of laparoscopic Nissen fundoplication with division and without division of short gastric vessels. Ann Surg 226: 642–652PubMedCrossRefGoogle Scholar
  45. 45.
    Lochegnies A, Hauters P, Janssen P, Nakad A, Farchack E, Defrennes M (2001) Quality-of-life assessment after Nissen fundoplication. Acta Chir Belg 101: 20–24PubMedGoogle Scholar
  46. 46.
    Kamolz T, Bammer T, Wykypiel H Jr, Pasiut M, Pointner R (2000) Quality of life and surgical outcome after laparoscopic Nissen and Toupet fundoplication: one-year follow-up. Endoscopy 32: 363–368PubMedCrossRefGoogle Scholar
  47. 47.
    Borgaonkar MR, Irvine EJ (2000) Quality-of-life measurement in gastrointestinal and liver disorders. Gut 47: 444–454PubMedCrossRefGoogle Scholar
  48. 48.
    Slim K, Bousquet J, Kwiatkowski F, Lescure G, Pezet D, Chipponi J (2000) Quality of life before and after laparoscopic fundoplication. Am J Surg 180: 41–45PubMedCrossRefGoogle Scholar
  49. 49.
    Kamolz T, Granderath F, Pointner R (2003) Laparoscopic antireflux surgery: disease-related quality-of-life assessment before and after surgery in GERD patients with and without Barrett’s esophagus. Surg Endosc 17: 880–885PubMedCrossRefGoogle Scholar
  50. 50.
    Nilsson G, Wenner J, Larsson S, Johnsson F (2004) Randomized clinical trial of laparoscopic versus open fundoplication for gastro-oesophageal reflux. Br J Surg 91: 552–559PubMedCrossRefGoogle Scholar
  51. 51.
    Urschel JD (1993) Complications of antireflux surgery. Am J Surg 166: 68–70PubMedGoogle Scholar
  52. 52.
    Rantanen TK, Salo JA, Sipponen JT (1999) Fatal and life-threatening complications in antireflux surgery: analysis of 5,502 operations. Br J Surg 86: 1573–1577PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2005

Authors and Affiliations

  • B. Dallemagne
    • 1
    Email author
  • J. Weerts
    • 1
  • S. Markiewicz
    • 1
  • J.-M. Dewandre
    • 1
  • C. Wahlen
    • 1
  • B. Monami
    • 1
  • C. Jehaes
    • 1
  1. 1.Department of Digestive SurgeryCHC-Les Cliniques Saint JosephBelgium

Personalised recommendations