Multicenter prospective evaluation of laparoscopic antireflux surgery

Abstract

A prospective study of 116 patients undergoing laparoscopic antireflux surgery was undertaken in four centers in the United Kingdom and the United States. Patients with a hiatal hernia (n = 80) underwent total Rosetti-Hell fundoplication, whereas those without a hiatal defect (n = 36) were treated by a partial fundoplication (Toupet). The follow-up period ranged from 3 to 24 months; median was 13 months. The median duration of the operations was 2.5 h. Intraoperative complications were encountered in 16 patients (14.0%) and conversion to laparotomy was necessary for esophageal perforation in one. The postoperative recovery of gastrointestinal function was rapid and the median hospital stay from the time of the operation to discharge was 2 days, range 1-10. A good symptomatic result (> 70% reduction of preoperative symptom score) was observed in 106 patients (91%). There were no postoperative deaths but 15 patients (13.0%) developed complications in the immediate postoperative period. At 3 months, complete endoscopic healing of the esophagitis was observed in 65/92 patients (71%) and improvement by at least one grade was seen in 19 patients (21%). Twenty-four-hour pH monitoring, which was abnormal preoperatively in 93% of patients, was normal after surgery in 95%. There were 10 symptomatic failures (persistent reflux symptoms) and 14 patients (12%) developed adverse symptoms related to the procedure (gas-bloat 8, dysphagia 9, gastroparesis 1, explosive diarrhoea 1). Readmission to hospital within 3 months was necessary in 9 patients. Laparoscopic antireflux surgery can be performed with a low morbidity. In the short term, 83% of patients were rendered symptom free. These results are similar to those reported after the equivalent open operations.