Laparoscopic nissen fundoplication for reflux esophagitis: The initial experience

Laparoscopic Nissen fundoplication is an alternative to open fundoplication in treating reflux esophagitis, providing an excellent result with less operative morbidity and a shorter hospital stay. This study was a retrospective review of 27 patients who underwent laparoscopic Nissen fundoplication for reflux esophagitis from September 1997 through July 1998. The purpose of the study was to report our operative technique and our analysis of the results with this procedure. All of the 27 patients, 22 men and 5 women, ranging in age from 20 to 75 years old, had symptomatic gastroesophageal reflux. Preoperative evaluation included upper gastrointestinal endoscopy, a barium upper GI study, esophageal manometry, and 24-hour pH monitoring. Upper GI endoscopy revealed esophagitis in 25 patients (92.6%), with Barrett's esophagitis in 1 patient and hiatal hernias in 14 patients (51.9%). The mean operation time was 220 minutes (range, 135 to 370 minutes). All patients tolerated a liquid diet on the first postoperative day. The mean hospital stay was 4 days. Perioperative complications occurred in 5 patients (18.5%), including 2 patients with pneumothorax, 2 with UGI bleeding, and 1 with postoperative dysphagia. Follow-up from 6 to 17 months showed complete relief of symptoms in 23 patients (85.2%). Laparoscopic Nissen fundoplication is a safe and effective procedure for patients with reflux esophagitis.