Anterior 180-Degree Partial Fundoplication: A 16-Year Experience with 548 Patients

Abstract

Previous randomized studies have shown that laparoscopic anterior 180-degree partial fundoplication achieves good control of gastroesophageal reflux, and with fewer side effects compared with Nissen fundoplication. Late clinical outcomes, however, remain uncertain, and outcomes from large series have not been reported. From August 1993 to November 2009, we performed 548 laparoscopic anterior 180-degree partial fundoplications. Perioperative data and clinical outcomes were determined prospectively using a structured questionnaire that evaluated heartburn, dysphagia, and satisfaction with clinical outcomes. Early and late clinical outcomes were evaluated in the overall group, and separately for patients with and without a large hiatus hernia. Five hundred and forty-eight patients (243 men, 305 women) underwent surgery, 380 primarily for gastroesophageal reflux and 168 with a large hiatus hernia. Fourteen patients (2.6%) underwent reoperation within 7 days of their original procedure, and later reoperation was required in 17 (3.1%) patients. Patients undergoing surgery for a large hiatus hernia were more likely to have a postoperative complication develop (13.7% versus 2.1%), more likely to undergo surgical revision in the first postoperative week (6.0% versus 1.1%), and less likely to undergo later revision (0.6% versus 4.2%), compared with patients undergoing surgery predominantly for reflux. Three-month, 1-, 5-, and 10-year follow-up was available for 511, 462, 233, and 89 patients, respectively. Heartburn and dysphagia scores were significantly improved at all postoperative time points compared with preoperative scores (p < 0.0001). Overall satisfaction with the outcomes of surgery remained stable across 10 years of follow-up. Laparoscopic anterior 180-degree partial fundoplication is an effective and durable alternative to Nissen fundoplication for the surgical treatment of gastroesophageal reflux.