Skip to main content

Advertisement

SpringerLink
Log in

Laparoscopic fundoplication: A 10-year learning curve

  • Original Articles
  • Published:
Surgical Endoscopy And Other Interventional Techniques Aims and scope Submit manuscript

Abstract

Background

Laparoscopic Nissen fundoplication (LNF) has become the most common surgical treatment for gastroesophageal reflux disease (GERD). Controversies still exist regarding the operative technique and the durability of the procedure.

Methods

A retrospective study of 808 patients undergoing 838 LNF for GERD at a tertiary referral center was undertaken. Demographic, perioperative, and follow-up data had been entered onto the unit database.

Results

During a median follow-up period of 60 months (range, 2–120 months), heartburn decreased to 3% of the patients (19/645) and regurgitation to 2% (11/582) (p < 0.01). Respiratory symptoms improved in 69 (85%) of 81 patients (p < 0.01). The incidence of postoperative dysphagia was unaffected by the use of an intraesophageal bougie (odds ratio [OR], 1.16; 95% confidence interval [CI], 0.82–1.64; p = 0.41) or division of the short gastric vessels (OR, 0.84; 95% CI, 0.42–1.07; p = 0.72). In the immediate postoperative period, the incidence of abdominal symptoms increased by 10% (p < 0.01) and dysphagia by 16% (p < 0.01). After 10 postoperative years, only 3% (30/484) were found to have abdominal symptoms, whereas the incidence of dysphagia declined to zero.

Conclusion

The findings show that LNF is a safe and effective procedure with long-term durability. Abdominal symptoms and dysphagia are the principal postoperative complaints, which improve with time. Personal preference should dictate the use of a bougie, division of the short gastric vessels, or both.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Dallemagne B, Weerts JM, Jehaes C (1991) Laparoscopic Nissen fundoplication: Preliminary report. Surg Laparosc Endosc 1: 138–143

    PubMed  CAS  Google Scholar 

  2. Geagea T (1991) Laparoscopic Nissen fundoplication: Preliminary report on 10 cases. Surg Endosc 5: 170–173

    PubMed  CAS  Google Scholar 

  3. Booth MI, Jones L, Stratford J, Dehn TC (2002) Results of laparoscopic Nissen fundoplication at 2–8 years after surgery. Br J Surg 89: 476–481

    Article  PubMed  CAS  Google Scholar 

  4. 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: 2331–2338

    Article  PubMed  CAS  Google Scholar 

  5. Stewart GD, Watson AJ, Lamb PJ, Lee AJ, Krukowski ZH, Griffin S, Paterson-Brown S (2004) Comparison of three different procedures for antireflux surgery. Br J Surg 91: 724–729

    Article  PubMed  CAS  Google Scholar 

  6. Pessaux P, Arnaud J, Ghavami B, Flament J, Trebuchet G, Meyer C, Huten N, Champault G (2000) Laparoscopic antireflux surgery: comparative study of Nissen, Nissen–Rosetti, and Toupet fundoplication. Surg Endosc 14: 1024–1027

    Article  PubMed  CAS  Google Scholar 

  7. 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: 165–170

    Article  PubMed  Google Scholar 

  8. Novitsky YW, Kercher KW, Callery MP, Czerniach DR, Kelly JJ, Li DE (2002) Is the use of a bougie necessary for laparoscopic Nissen fundoplication. Arch Surg 137: 402–406

    Article  PubMed  Google Scholar 

  9. Anvari M, Allen C (1998) Laparoscopic Nissen fundoplication: two-year comprehensive follow-up of a technique of minimal paraesophageal dissection. Ann Surg 227(1): 25–32

    Article  PubMed  CAS  Google Scholar 

  10. Abbas AE, Deschamps C, Cassivi SD, Allen MS, Nichols FC, Mil DL, Pairolero PC (2004) Barrett’s esophagus: the role of laparoscopic fundoplication. Ann Thorac Surg 77: 393–396

    Article  PubMed  Google Scholar 

  11. DeMeester TR, Bonavina L, Albertucci M (1986) Nissen fundoplication for gastroesophageal reflux disease: evaluation of primary repair in 100 consecutive patients. Ann Surg 204: 9–20

    Article  PubMed  CAS  Google Scholar 

  12. Desai KM, Frisella MM, Soper NJ (2003) Clinical outcomes after laparoscopic antireflux surgery in patients with and without preoperative endoscopic esophagitis. J Gastrointest Surg 7: 44–51, discussion 51–52

    Article  PubMed  Google Scholar 

  13. Allen CJ, Anvari M (2004) Does laparoscopic fundoplication provide long-term control of gastroesophageal reflux–related cough? Surg Endosc 18: 633–637

    Article  PubMed  CAS  Google Scholar 

  14. Spivak H, Lelcuk S, Hunter JG (1999) Laparoscopic surgery of the gastroesophageal junction. World J Surg 23: 356–367

    Article  PubMed  CAS  Google Scholar 

  15. Baigrie RJ, Watson DI, Myers JC, Jamieson GG (1997) Outcome of laparoscopic Nissen fundoplication in patients with disordered preoperative peristalsis. Gut 40: 381–385

    PubMed  CAS  Google Scholar 

  16. Booth M, Stratford J, Dehn TC (2002) Preoperative esophageal body motility does not influence the outcome of laparoscopic Nissen fundoplication for gastroesophageal disease. Dis Esophagus 15: 57–60

    Article  PubMed  CAS  Google Scholar 

  17. Fibbe C, Layer P, Keller J, Strate U, Emmerman A, Zorning C (2001) Esophageal motility in reflux disease before and after fundoplication: a prospective randomized clinical and manometric study. Gastrenterology 121: 5–14

    Article  CAS  Google Scholar 

  18. Heider TR, Behns KE, Koruda MJ, Shaheens NJ, Lucktag TA, Bradshaw B, Farrel TM (2003) Fundoplication improves disordered esophageal motility. J Gastrointestinal Surg 7: 159–163

    Article  Google Scholar 

  19. O’Boyle CJ, Watson DI, DeBeaux AC, Jamieson GG (2002) Preoperative prediction of long-term outcome following laparoscopic fundoplication. ANZ J Surg 72: 471–475

    Article  PubMed  Google Scholar 

  20. Walsh JD, Landercasper J, Boyd WC, Lambert PJ, Havlik PJ (2003) Patient outcomes and dysphagia after laparoscopic antireflux surgery performed without use of intraoperative esophageal dilators. Am Surg 69: 219–223, discussion 223–224

    PubMed  Google Scholar 

  21. Hunter JG, Swanstrom L, Waring JP (1996) Dysphagia after laparoscopic antireflux surgery: the impact of operative technique. Ann Surg 224: 51–57

    Article  PubMed  CAS  Google Scholar 

  22. 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: 642–652

    Article  PubMed  CAS  Google Scholar 

  23. Sato K, Awad ZT, Filipi CJ, Selima MA, Cummings JE, Fenton SJ, Hinder RA (2002) Causes of long-term dysphagia after laparoscopic Nissen fundoplication. Journal of Society Laparoendoscopic Surgeons 6: 35–40

    Google Scholar 

  24. Geagea T (1994) Laparoscopic Nissen–Rossetti fundoplication. Surg Endosc 8: 1080–1084

    Article  PubMed  CAS  Google Scholar 

  25. Zaninotto G, Molena D, Ancona E (2000) A prospective multicenter study on laparoscopic treatment of gastroesophageal reflux disease in Italy: type of surgery, conversions, complications, and early results. Study Group for the Laparoscopic Treatment of Gastroesophageal Reflux Disease of the Italian Society of Endoscopic Surgery (SICE). Surg Endosc 14: 282–288

    Article  PubMed  CAS  Google Scholar 

  26. O’Boyle CJ, Heer K, Smith A, Sedman PC, Brough WA, Royston CM (2000) Iatrogenic thoracic migration of the stomach complicating laparoscopic Nissen fundoplication. Surg Endosc 14: 540–542

    Article  PubMed  CAS  Google Scholar 

  27. Watson DI, Jamieson GG, Devitt PG, Ackroyd R, Lafullarde T, Game PA, Kennedy JA, Ellis T (2001) A prospective randomized trial of laparoscopic Nissen fundoplication with anterior vs posterior hiatal repair. Arch Surg 136: 745–751

    Article  PubMed  CAS  Google Scholar 

  28. Watson DI, Baigrie RJ, Jamieson GG (1996) A learning curve for laparoscopic fundoplication: definable, avoidable, or a waste of time? Ann Surg 2: 198–203

    Article  Google Scholar 

  29. Dagash H, Chowdhury M, Pierro A (2003) When can I be proficient in laparoscopic surgery?A systematic review of the evidence. J Pediatr Surg 38: 720–724

    Article  PubMed  Google Scholar 

  30. Neuhauser B, Hinder RA (2001) Laparoscopic reoperation after failed antireflux surgery. Semin Laparosc Surg 8: 281–286, review

    Article  PubMed  CAS  Google Scholar 

  31. 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: 812–818

    Article  PubMed  Google Scholar 

  32. Rydberg L, Ruth M, Abrahamsson H, Lundell L (1999) Tailoring antireflux surgery: a randomized clinical trial. World J Surg 23: 612–618

    Article  PubMed  CAS  Google Scholar 

  33. Gotley DC, Smithers BM, Menzies B, Branicki FJ, Rhodes M, Nathanson L (1996) Laparoscopic Nissen fundoplication and postoperative dysphagia: can it be predicted? Ann Acad Med Singapore 25: 646–649

    PubMed  CAS  Google Scholar 

  34. De Beaux AC, Watson DI, O’Boyle C, Jamieson GG (2001) Role of fundoplication in patient symptomatology after laparoscopic antireflux surgery. Br J Surg 88: 1117–1121

    Article  PubMed  Google Scholar 

  35. O’Brien CJ, Collin SSA, Collins BJ, Mcligan J (1990) Aperistaltic oesophageal disorders unmasked by severe postfundoplication dysphagia. Postgrad Med J 6: 1047–1049

    Article  Google Scholar 

  36. Poulin E, Diamant E, Kortan P, Sesbadri P, Scblacbta C, Mamazza J (2000) Achalasia developing years after surgery for reflux disease: case reports, laparoscopic treatment, and review of achalasia syndromes following antireflux surgery. J Gastrointest Surg 4: 626–631

    Article  PubMed  CAS  Google Scholar 

  37. Greason KL, Miller DL, Deschamps C, Allen MS, Nichols FC, Trastec VF, Pairolero PC (2002) Effects of antireflux procedure on respiratory symptoms. Ann Thorac Surg 73: 381–385

    Article  PubMed  Google Scholar 

  38. Duffy JP, Maggard M, Hiyamma DT, Atkinson JB, McFadden DW, Hines OJ (2003) Laparoscopic Nissen fundoplication improves quality of in patients with atypical symptoms of gastroesophageal reflux. Am Surg 69: 833–838

    PubMed  Google Scholar 

  39. Novitsky YW, Zawacki JK, Irwin RS, French CT, Hussey VM, Calley MP (2002) Chronic cough due to gastroesophageal disease: efficacy of antireflux surgery. Surg Endosc 16: 567–571

    Article  PubMed  CAS  Google Scholar 

  40. Brouwer R, Kiroff GK (2003) Improvement of respiratory symptoms following laparoscopic Nissen fundoplication. ANZ J Surg 73: 189–193

    Article  PubMed  Google Scholar 

  41. Hofstetter WL, Peters JH, DeMeester TR, Hagen JA, DeMeester SR, Crookes PF, Tsai P, Banki F, Bremner CG (2001) Long-term outcome of antireflux surgery in patients with Barrett’s esophagus. Ann Surg 234: 532–538, discussion 538–539

    Article  PubMed  CAS  Google Scholar 

  42. Campos GM, DeMeester SR, Peters JH, Oberg S, Crookes PF, Hagen JA, Bremner CG, Sillin LF III, Mason RJ, DeMeester TR (2001) Predictive factors of Barrett esophagus: multivariate analysis of 502 patients with gastroesophageal reflux disease. Arch Surg 136: 1267–1273

    Article  PubMed  CAS  Google Scholar 

  43. Galvani C, Fisichella PM, Gorodner MV, Perretta S, Patti MG (2003) Symptoms are a poor indicator of reflux status after fundoplication for gastroesophageal reflux disease: role of esophageal functions tests. Arch Surg 138: 514–518, discussion 518–519

    Article  PubMed  Google Scholar 

  44. Lord RV, Kaminski A, Oberg S, Bowrey DJ, Hagen JA, DeMeester SR, Sillin LF, Peters JH, Crookes PF, DeMeester TR (2002) Absence of gastroesophageal reflux disease in a majority of patients taking acid suppression medications after Nissen fundoplication. J Gastrointest Surg 6: 3–9, discussion 10

    Article  PubMed  Google Scholar 

  45. Bammer T, Hinder RA, Klaus A, Klingler PJ (2001) Five- to eight-year outcome of the first laparoscopic Nissen fundoplications. J Gastrointest Surg 5: 42–48

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, University Hospital of Larisa, Larisa, Greece

    D. Zacharoulis

  2. Division of Upper Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ, UK

    C. J. O’Boyle, P. C. Sedman, W. A. Brough & C. M. S. Royston

Authors
  1. D. Zacharoulis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. J. O’Boyle
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. C. Sedman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. W. A. Brough
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. M. S. Royston
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. M. S. Royston.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zacharoulis, D., O’Boyle, C.J., Sedman, P.C. et al. Laparoscopic fundoplication: A 10-year learning curve. Surg Endosc 20, 1662–1670 (2006). https://doi.org/10.1007/s00464-005-0571-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-005-0571-1

Keywords

Search

Navigation