Ten-year Outcome of Laparoscopic Antireflux Surgery
Reflux recurrence is the most common long-term complication of fundoplication. Its frequency was independent from the type of fundoplication in randomized studies. Results for different techniques of laparoscopic antireflux surgery were retrospectively evaluated after 10 years.
From 1992 to 1997, 120 patients had primary laparoscopic fundoplication with a “tailored approach” (type of wrap chosen according to esophageal peristalsis): 88 received a Nissen, 22 an anterior, and 10 a Toupet fundoplication. Follow-up of 87% of the patients included disease-related questions and the gastrointestinal quality-of-life index (GIQLI).
Of the patients, 89% would select surgery again. Heartburn was reported by 30% of the patients. Regurgitations were noted from 15% of patients after a Nissen, 44% after anterior fundoplication, and 10% after a Toupet (p = 0.04). Twenty-eight percent were on acid-suppressive drugs again. Following Nissen fundoplication, proton pump inhibitors were less frequently used (p = 0.01) and on postoperative pH-metry reflux recurrence rate was lower (p = 0.04). The GIQLI was 110 ± 24 without significant differences for the type of fundoplication.
Ten years after laparoscopic fundoplication, overall outcome is good. A quarter of the patients are on acid-suppressive drugs. Nissen fundoplication appears to control reflux better than a partial fundoplication.
KeywordsGastroesophageal reflux disease Antireflux surgery Long-term outcome Reflux recurrence
The corresponding author declares that none of the authors has any connections whatsoever with the companies whose products are named in this paper or with any company in competition with those companies. The presentation of the topic is impartial and the contents are entirely product-neutral.
- 1.Lundell L, Abrahamsson H, Ruth M, Rydberg L, Lönroth H, Olbe L. Long-term results of a prospective randomized comparison of total fundic wrap (Nissen-Rossetti) or semifundoplication (Toupet) for gastroesophageal reflux. Br J Surg 1996;83:830–835. doi: 10.1002/bjs.1800830633.PubMedCrossRefGoogle Scholar
- 19.Lord RV, Kaminski A, Oberg S, Bowrey DJ, Hagen JA, DeMeester SR et al. Absence of gastroesophageal reflux disease in a majority of patients taking acid suppression medications after Nissen fundoplication. J Gastrointest Surg. 2002;6:3–9. doi: 10.1016/S1091-255X(01)00031-2.PubMedCrossRefGoogle Scholar