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Rodney J. Landreneau
Robert J. Wiechmann
Stephen R. Hazelrigg
Mitchell J. Magee
Keith S. Naunheim
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Ann Thorac Surg 1998;66:1886-1892
© 1998 The Society of Thoracic Surgeons

Original Articles

Success of laparoscopic fundoplication for gastroesophageal reflux disease1

Rodney J. Landreneau, MDa, Robert J. Wiechmann, MDa, Stephen R. Hazelrigg, MDc, Tibetha S. Santucci, RNa, Theresa M. Boley, MSNc, Mitchell J. Magee, MDc, Keith S. Naunheim, MDb

a Allegheny University Hospitals, Allegheny General, Allegheny University of the Health Sciences, Pittsburgh, Pennsylvania, USA
b St. Louis University Medical Center, St. Louis, Missouri, USA
c University of Southern Illinois Medical Center, Springfield, Illinois, USA

Address reprint requests to Dr Landreneau, Division of Thoracic Surgery, Allegheny University of the Health Sciences, Suite 0242, 02 Level, South Tower, Allegheny General Hospital, 320 East North Ave, Pittsburgh, PA 15212-4772

Presented at the Thirty-fourth Annual Meeting of The Society of Thoracic Surgeons, New Orleans, LA, Jan 26–28, 1998.

Background. We explored the efficacy of laparoscopic fundoplication (LF) in patients with uncomplicated, medically recalcitrant pathologic gastroesophageal reflux disease (GERD) for whom we previously would have recommended open surgical repair.

Methods. From January 1994 to January 1998, we performed LF on 150 patients (80 men and 70 women) with GERD recalcitrant to maximal medical therapy. No patient suffered from esophageal stricture or epithelial dysplasia; however 16% (24 of 150) had benign Barrett’s mucosa. Preoperative esophageal manometry and 24-hour pH testing were obtained in 93% (139 of 150) and 89% (134 of 150) of patients, respectively. Nissen LF (n = 123), Toupet LF (n = 26), or Dor LF (n = 1) were accomplished over a large (54 F) intraesophageal bougie. Preoperative (1 month) and postoperative (>6 month) symptom scoring were assessed on a 0 to 10 scale. Thirty-eight patients with a greater than 6-month postoperative period had manometry and pH studies performed.

Results. The laparoscopic approach was successful in 99% (148 of 150) of patients, and there has been no mortality. Operative time was 160 ± 59 minutes. Open conversion was required for 2 patients: because of difficulty with dissection owing to adhesions in 1 case and due to perforation in another. Reoperation was required for 5 patients (1 paraesophageal, 2 dysphagia, 2 recurrent reflux). Major postoperative complications involved stroke and pancreatitis in 1 patient each. Mean hospital stay was 2.6 ± 1.2 days, full activity resumed by 7 days. Postoperative esophageal pH testing among 38 patients tested more than 6 months after operation demonstrated normal esophageal acid exposure in all but 2. GERD symptoms were relieved at 1 month, 6 months, and after 1 year in 95% (128 of 135), 94% (99 of 105), and 93% (65 of 70) of patients, respectively.

Conclusions. Intermediate-term results with LF suggest this to be a reasonable approach to surgical management of medically recalcitrant uncomplicated GERD. Thoracic surgeons interested in GERD should become familiar with minimally invasive surgical approaches.




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