Laparoscopic Nissen fundoplication - 200 consecutive cases

Patients-Laparoscopic Nissen fundoplication was undertaken in 200 patients between 1991 and 1994. Methods-Pre-operative assessment included symptom score, endoscopy, manometry, and 24 hour pH monitoring of the oesophagus. Patients were evaluated at three and 12 months after surgery with symptom scoring and 96 patients also underwent 24 hour pH studies at three to six months postoperatively. Results-In the first 100 patients median duration of operation was 155 minutes (range: 70-330), conversion rate to laparotomy was 7%, median hospital stay was three days (range: 2-57), and total morbidity was 16%. This compared with a median operation time of 120 minutes (60-240) (p=0.0003, 95% CI 10, 40), a conversion rate of 2% (p=0.2), a hospital stay of three days (1-18) (p=0.0016, 95% CI 0, 1), and total morbidity of 7% (p=0.15) in the second 100 patients. Median total symptom scores fell from 5/9 to 0/9 after fundoplication (<0.0001) while median 24 hour oesophageal acid exposure in 96 patients was reduced from 10% to 1% (p<0.001). Conclusions-Laparoscopic Nissen fundoplication is a safe and effective procedure for gastro-oesophageal reflux disease. With experience, the duration of operation falls and the hospital stay is shorter. Short-term symptomatic and pH results are consistently improved by surgery.