Skip to main content
NCBI home page
Annals of Surgery logoLink to Annals of Surgery
. 1998 Jan;227(1):25–32. doi: 10.1097/00000658-199801000-00004

Laparoscopic Nissen fundoplication: two-year comprehensive follow-up of a technique of minimal paraesophageal dissection.

M Anvari 1, C Allen 1
PMCID: PMC1191168  PMID: 9445106

Abstract

OBJECTIVE: To provide a comprehensive follow-up of 381 patients after laparoscopic Nissen fundoplication (LNF) using a technique of minimal paraesophageal dissection. METHODS: Patients underwent a 24-hour pH recording, esophageal manometry, and symptom score assessment for six symptoms of gastroesophageal reflux disease preoperatively. To date, 260 patients have undergone repeat studies at 6 months and 108 patients at 2 years. RESULTS: LNF was associated with a significant (p < 0.0001) increase in the lower esophageal sphincter (LES) pressure and a significant (p < 0.0001) drop in duration of acid reflux in 24 hours and symptom score 6 and 24 months after surgery when compared to preoperative values. Twelve patients (3%) have experienced recurrence of reflux symptoms, 8 presenting in the first 6 months and 4 by the second year after surgery, but only 1 has required repeat surgery. The incidence of clinical dysphagia was found to be 1.3% of the patient group. CONCLUSIONS: LNF remains an effective antireflux procedure at 2 years. Most recurrences occur early, and there is no significant deterioration in the high-pressure zone at the LES, the percentage reflux in 24 hours, or symptom control between 6 months and 2 years after surgery, suggesting that the long-term results should be satisfactory.

Full text

PDF
25

Images in this article

28Figure 2.
on p.28

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anvari M., Allen C. J. Prospective evaluation of dysphagia before and after laparoscopic Nissen fundoplication without routine division of short gastrics. Surg Laparosc Endosc. 1996 Dec;6(6):424–429. [PubMed] [Google Scholar]
  2. Anvari M., Allen C., Borm A. Laparoscopic Nissen fundoplication is a satisfactory alternative to long-term omeprazole therapy. Br J Surg. 1995 Jul;82(7):938–942. doi: 10.1002/bjs.1800820728. [DOI] [PubMed] [Google Scholar]
  3. Breumelhof R., Fellinger H. W., Vlasblom V., Jansen A., Smout A. J. Dysphagia after Nissen fundoplication. Dysphagia. 1991;6(1):6–10. doi: 10.1007/BF02503457. [DOI] [PubMed] [Google Scholar]
  4. Dallemagne B., Weerts J. M., Jehaes C., Markiewicz S., Lombard R. Laparoscopic Nissen fundoplication: preliminary report. Surg Laparosc Endosc. 1991 Sep;1(3):138–143. [PubMed] [Google Scholar]
  5. DeMeester T. R., Bonavina L., Albertucci M. Nissen fundoplication for gastroesophageal reflux disease. Evaluation of primary repair in 100 consecutive patients. Ann Surg. 1986 Jul;204(1):9–20. doi: 10.1097/00000658-198607000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Donahue P. E., Larson G. M., Stewardson R. H., Bombeck C. T. Floppy Nissen fundoplication. Rev Surg. 1977 Jul-Aug;34(4):223–224. [PubMed] [Google Scholar]
  7. Gotley D. C., Smithers B. M., Rhodes M., Menzies B., Branicki F. J., Nathanson L. Laparoscopic Nissen fundoplication--200 consecutive cases. Gut. 1996 Apr;38(4):487–491. doi: 10.1136/gut.38.4.487. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Grande L., Toledo-Pimentel V., Manterola C., Lacima G., Ros E., García-Valdecasas J. C., Fuster J., Visa J., Pera C. Value of Nissen fundoplication in patients with gastro-oesophageal reflux judged by long-term symptom control. Br J Surg. 1994 Apr;81(4):548–550. doi: 10.1002/bjs.1800810421. [DOI] [PubMed] [Google Scholar]
  9. Hinder R. A., Filipi C. J., Wetscher G., Neary P., DeMeester T. R., Perdikis G. Laparoscopic Nissen fundoplication is an effective treatment for gastroesophageal reflux disease. Ann Surg. 1994 Oct;220(4):472–483. doi: 10.1097/00000658-199410000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Hinder R. A., Stein H. J., Bremner C. G., DeMeester T. R. Relationship of a satisfactory outcome to normalization of delayed gastric emptying after Nissen fundoplication. Ann Surg. 1989 Oct;210(4):458–465. doi: 10.1097/00000658-198910000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Hunter J. G., Trus T. L., Branum G. D., Waring J. P., Wood W. C. A physiologic approach to laparoscopic fundoplication for gastroesophageal reflux disease. Ann Surg. 1996 Jun;223(6):673–687. doi: 10.1097/00000658-199606000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Jamieson G. G., Watson D. I., Britten-Jones R., Mitchell P. C., Anvari M. Laparoscopic Nissen fundoplication. Ann Surg. 1994 Aug;220(2):137–145. doi: 10.1097/00000658-199408000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Klinkenberg-Knol E. C., Festen H. P., Jansen J. B., Lamers C. B., Nelis F., Snel P., Lückers A., Dekkers C. P., Havu N., Meuwissen S. G. Long-term treatment with omeprazole for refractory reflux esophagitis: efficacy and safety. Ann Intern Med. 1994 Aug 1;121(3):161–167. doi: 10.7326/0003-4819-121-3-199408010-00001. [DOI] [PubMed] [Google Scholar]
  14. Larrain A., Carrasco E., Galleguillos F., Sepulveda R., Pope C. E., 2nd Medical and surgical treatment of nonallergic asthma associated with gastroesophageal reflux. Chest. 1991 Jun;99(6):1330–1335. doi: 10.1378/chest.99.6.1330. [DOI] [PubMed] [Google Scholar]
  15. Marcuard S. P., Albernaz L., Khazanie P. G. Omeprazole therapy causes malabsorption of cyanocobalamin (vitamin B12) Ann Intern Med. 1994 Feb 1;120(3):211–215. doi: 10.7326/0003-4819-120-3-199402010-00006. [DOI] [PubMed] [Google Scholar]
  16. McKenzie D., Grayson T., Polk H. C., Jr The impact of omeprazole and laparoscopy upon hiatal hernia and reflux esophagitis. J Am Coll Surg. 1996 Oct;183(4):413–418. [PubMed] [Google Scholar]
  17. NISSEN R. Eine einfache Operation zur Beeinflussung der Refluxoesophagitis. Schweiz Med Wochenschr. 1956 May 18;86(Suppl 20):590–592. [PubMed] [Google Scholar]
  18. Parkinson A., Hurwitz A. Omeprazole and the induction of human cytochrome P-450: a response to concerns about potential adverse effects. Gastroenterology. 1991 Apr;100(4):1157–1164. doi: 10.1016/0016-5085(91)90317-e. [DOI] [PubMed] [Google Scholar]
  19. Spechler S. J. Comparison of medical and surgical therapy for complicated gastroesophageal reflux disease in veterans. The Department of Veterans Affairs Gastroesophageal Reflux Disease Study Group. N Engl J Med. 1992 Mar 19;326(12):786–792. doi: 10.1056/NEJM199203193261202. [DOI] [PubMed] [Google Scholar]
  20. Stein H. J., Bremner R. M., Jamieson J., DeMeester T. R. Effect of Nissen fundoplication on esophageal motor function. Arch Surg. 1992 Jul;127(7):788–791. doi: 10.1001/archsurg.1992.01420070040010. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES