Laparoscopic Nissen
fundoplication was first undertaken in the early 1990s. Appreciable numbers of patients with 10-year follow up are only now available. This study assesses long-term outcome and durability of outcome after laparoscopic Nissen
fundoplication for treatment of
gastro-esophageal reflux disease. Since 1991, 829 patients have undergone laparoscopic fundoplications and are prospectively followed. Two hundred thirty-nine patients, 44 per cent male, with a median age of 53 years (+/- 15 standard deviation) underwent laparoscopic Nissen fundoplications at least 10 years ago; 28 (12%) patients were "redo" fundoplications. Before and after
fundoplication, among many symptoms, patients scored the frequency and severity of
dysphagia,
chest pain,
vomiting, regurgitation,
choking, and
heartburn using a Likert scale (0 = never/not bothersome to 10 = always/very bothersome). Symptom scores before versus after
fundoplication were compared using a Wilcoxon matched-pairs test. Data are reported as median, mean +/- standard deviation, when appropriate. After
fundoplication,
length of stay was 2 days, 3 days +/- 4.8. Intra-operative inadvertent events were uncommon and without sequela: 1 esophagotomy, 1 gastrotomy, 3 cardiac dysrhythmias, and 3 CO2 pneumothoraces. Complications after
fundoplication included: 1 postpneumonic
empyema, 3 urinary retentions, 2 superficial
wound infections, 1
urinary tract infection, 1
ileus, and 1 intraabdominal
abscess. There were two perioperative deaths; 88 per cent of the patients are still alive. After laparoscopic Nissen
fundoplication, frequency and severity scores dramatically improved for all symptoms queried (P < 0.001), especially for
heartburn frequency (8, 8 +/- 3.2 versus 2, 3 +/- 2.8, P < 0.001) and severity (10, 8 +/- 2.9 versus 1, 2 +/- 2.5, P < 0.001). Eighty per cent of patients rate their symptoms as almost completely resolved or greatly improved, and 85 per cent note they would again have the laparoscopic
fundoplication as a result of analysis of our initial experience, thereby promoting superior outcomes in the future. Nonetheless, follow up
at 10 years and beyond of our initial experience documents that laparoscopic
fundoplication durably provides high patient satisfaction resulting from long-term amelioration of the frequency and severity of symptoms of
gastroesophageal reflux disease. These results promote further application of laparoscopic Nissen
fundoplication.