Laparoscopic antireflux surgery for gastroesophageal reflux disease: experience with 668 laparoscopic antireflux procedures

In the past decade laparoscopic antireflux surgery has become the standard operation for treating severe gastroesophageal reflux disease. Several studies have been published showing that it can achieve good to excellent results at short- and medium-term follow-up. We present our experience with 668 laparoscopic antireflux procedures. Between September 1993 and July 2001 we performed 668 laparoscopic antireflux procedures (76% laparoscopic 360 degrees "floppy" Nissen fundoplications in patients with normal esophageal motility, 24% laparoscopic 270 degrees Toupet partial fundoplications in patients with poor esophageal motility or severely disordered peristalsis). Patients with achalasia were excluded from analysis. Preoperative and postoperative data including 24-h pH monitoring, esophageal manometry, and analysis of failure were prospectively reviewed. Overall complication rate was 7.6%. Conversion to open surgery was necessary in five patients (0.8%). Seventy-four laparoscopic redo procedures were performed due to failed primary intervention. There was no death. At a mean follow-up of 4.8 years (range 3-94 months) 24-h pH monitoring and esophageal manometry showed normal values in 93% of patients. Laparoscopic antireflux surgery is feasible and effective and can be performed safely without mortality and low morbidity with good to excellent functional and symptomatic results.