Abstract
Background: Laparoscopic fundoplication has become the standard for operative treatment of gastroesophageal reflux disease (GERD). Methods: We reviewed our experience with 1,000 consecutive patients receiving laparoscopic fundoplication for GERD (n = 882) or paraesophageal hernia (n = 118) between October 1991 and July 1999. Patients with achalasia and failed fundoplication were excluded from analysis. All the patients were evaluated preoperatively by upper endoscopy, esophageal manometry, and barium swallow. After 1994, 24-h pH monitoring was performed selectively in patients with extraesophageal symptoms and/or those without erosive esophagitis. There were 490 men 510 women in this review. Their mean age was 49 years. Procedures performed were 360° floppy fundoplication (n = 879), 360° fundoplication without fundus mobilization (Rossetti) (n = 22), 270° posterior fundoplication (n = 96), and anterior fundoplication (n = 2). Esophageal lengthening procedure (Collis gastroplasty) was performed in combination with fundoplication in 15 patients. In seven patients the treatment was converted to open fundoplication. Outcomes: The average length of hospitalization was 2.2 days, and 136 patients stayed longer than 2 days. Major complications occurred in 21 patients: esophageal perforation (n= 10), acute paraesophageal herniation (n = 4), splenic bleeding (n = 2), cardiac arrest (n = 1), pneumonia (n = 3), and testicular abscess (n = 1). Additional operations were required to manage the complications in 14 patients (70%): Four of these procedures were performed emergently, and 10 patients underwent reoperation between 6 h and 10 days. There were three deaths, all of which involved elderly patients with paraesophageal hernia. There were 35 late failures requiring reoperation for recurrence of GERD or development of new symptoms: The treatment of 32 patients was revised laparoscopically, and 4 patients required laparotomy. Beyond 1 year (median follow-up period, 27 months), 94% of the reviewed patients were satisfied with their surgical outcome.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 691-699 |
| Number of pages | 9 |
| Journal | Surgical Endoscopy and Other Interventional Techniques |
| Volume | 15 |
| Issue number | 7 |
| DOIs | |
| State | Published - 2001 |
| Externally published | Yes |
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Keywords
- GERD
- Laparoscopic surgery
- Nissen fundoplication
- Paraesophageal hernia
ASJC Scopus subject areas
- Surgery
Cite this
Outcomes of laparoscopic fundoplication for gastroesophageal reflux disease and paraesophageal hernia : Experience with 1,000 consecutive cases. / Terry, M.; Smith, C. D.; Branum, G. D.; Galloway, K.; Waring, J. P.; Hunter, John.
In: Surgical Endoscopy and Other Interventional Techniques, Vol. 15, No. 7, 2001, p. 691-699.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Outcomes of laparoscopic fundoplication for gastroesophageal reflux disease and paraesophageal hernia
T2 - Experience with 1,000 consecutive cases
AU - Terry, M.
AU - Smith, C. D.
AU - Branum, G. D.
AU - Galloway, K.
AU - Waring, J. P.
AU - Hunter, John
PY - 2001
Y1 - 2001
N2 - Background: Laparoscopic fundoplication has become the standard for operative treatment of gastroesophageal reflux disease (GERD). Methods: We reviewed our experience with 1,000 consecutive patients receiving laparoscopic fundoplication for GERD (n = 882) or paraesophageal hernia (n = 118) between October 1991 and July 1999. Patients with achalasia and failed fundoplication were excluded from analysis. All the patients were evaluated preoperatively by upper endoscopy, esophageal manometry, and barium swallow. After 1994, 24-h pH monitoring was performed selectively in patients with extraesophageal symptoms and/or those without erosive esophagitis. There were 490 men 510 women in this review. Their mean age was 49 years. Procedures performed were 360° floppy fundoplication (n = 879), 360° fundoplication without fundus mobilization (Rossetti) (n = 22), 270° posterior fundoplication (n = 96), and anterior fundoplication (n = 2). Esophageal lengthening procedure (Collis gastroplasty) was performed in combination with fundoplication in 15 patients. In seven patients the treatment was converted to open fundoplication. Outcomes: The average length of hospitalization was 2.2 days, and 136 patients stayed longer than 2 days. Major complications occurred in 21 patients: esophageal perforation (n= 10), acute paraesophageal herniation (n = 4), splenic bleeding (n = 2), cardiac arrest (n = 1), pneumonia (n = 3), and testicular abscess (n = 1). Additional operations were required to manage the complications in 14 patients (70%): Four of these procedures were performed emergently, and 10 patients underwent reoperation between 6 h and 10 days. There were three deaths, all of which involved elderly patients with paraesophageal hernia. There were 35 late failures requiring reoperation for recurrence of GERD or development of new symptoms: The treatment of 32 patients was revised laparoscopically, and 4 patients required laparotomy. Beyond 1 year (median follow-up period, 27 months), 94% of the reviewed patients were satisfied with their surgical outcome.
AB - Background: Laparoscopic fundoplication has become the standard for operative treatment of gastroesophageal reflux disease (GERD). Methods: We reviewed our experience with 1,000 consecutive patients receiving laparoscopic fundoplication for GERD (n = 882) or paraesophageal hernia (n = 118) between October 1991 and July 1999. Patients with achalasia and failed fundoplication were excluded from analysis. All the patients were evaluated preoperatively by upper endoscopy, esophageal manometry, and barium swallow. After 1994, 24-h pH monitoring was performed selectively in patients with extraesophageal symptoms and/or those without erosive esophagitis. There were 490 men 510 women in this review. Their mean age was 49 years. Procedures performed were 360° floppy fundoplication (n = 879), 360° fundoplication without fundus mobilization (Rossetti) (n = 22), 270° posterior fundoplication (n = 96), and anterior fundoplication (n = 2). Esophageal lengthening procedure (Collis gastroplasty) was performed in combination with fundoplication in 15 patients. In seven patients the treatment was converted to open fundoplication. Outcomes: The average length of hospitalization was 2.2 days, and 136 patients stayed longer than 2 days. Major complications occurred in 21 patients: esophageal perforation (n= 10), acute paraesophageal herniation (n = 4), splenic bleeding (n = 2), cardiac arrest (n = 1), pneumonia (n = 3), and testicular abscess (n = 1). Additional operations were required to manage the complications in 14 patients (70%): Four of these procedures were performed emergently, and 10 patients underwent reoperation between 6 h and 10 days. There were three deaths, all of which involved elderly patients with paraesophageal hernia. There were 35 late failures requiring reoperation for recurrence of GERD or development of new symptoms: The treatment of 32 patients was revised laparoscopically, and 4 patients required laparotomy. Beyond 1 year (median follow-up period, 27 months), 94% of the reviewed patients were satisfied with their surgical outcome.
KW - GERD
KW - Laparoscopic surgery
KW - Nissen fundoplication
KW - Paraesophageal hernia
UR - http://www.scopus.com/inward/record.url?scp=0034943393&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0034943393&partnerID=8YFLogxK
U2 - 10.1007/s004640080144
DO - 10.1007/s004640080144
M3 - Article
C2 - 11591970
AN - SCOPUS:0034943393
VL - 15
SP - 691
EP - 699
JO - Surgical Endoscopy and Other Interventional Techniques
JF - Surgical Endoscopy and Other Interventional Techniques
SN - 0930-2794
IS - 7
ER -