Early outcome after laparoscopic and open floppy Nissen fundoplication

Abstract

AIMS: There remains debate regarding the best operative procedure for gastro-oesophageal reflux. For those who advocate a full 'floppy' Nissen fundoplication there is some scepticism that this can be completed effectively laparoscopically with division of all the short gastric vessels. This study therefore compared the results of patients operated on in two different hospitals in which floppy Nissen fundoplication was carried out either laparoscopically (hospital 1) or by open surgery (hospital 2). METHODS: All patients undergoing antireflux surgery in both hospitals were recorded prospectively and perioperative data were collected retrospectively from the case records. A postoperative questionnaire was sent to each patient to determine the modified DeMeester score and the impact of surgery on daily activities, which were then analysed anonymously by an independent clinician. RESULTS: Operating time was significantly longer (median 150 versus 75 min; P < 0.001), but postoperative stay (2 versus 4 days; P < 0.001) and return to normal activities (14 versus 25 days; P < 0.002) were shorter for the laparoscopic approach. There was no difference in gas bloat (both groups median 1.0, range 0-3), dysphagia (median 1.0 versus 0.0, range 0-3) or modified DeMeester score (both groups median 1.0, range 0-9) between the two techniques (median follow-up 10 and 15 months). CONCLUSIONS: As the postoperative results were comparable this study confirms that a 'floppy' Nissen fundoplication with complete mobilization of the gastric fundus can be performed laparoscopically. The advantages of a shorter hospital stay and earlier return to normal activities are offset by a longer operating time.