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Surg Laparosc Endosc. 1997 Feb;7(1):17-21.

Laparoscopic Nissen fundoplication: where do we stand?

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Dept. of Surgery, Creighton University School of Medicine, Omaha, NE 68131, USA.


Laparoscopic Nissen fundoplication was first performed in 1991. With the increasing number of these procedures being performed it is appropriate to review the published short-term results. A retrospective review of reports on this subject was performed. There were a total of 2453 patients available for review. Twenty-five of 2453 (1.0%) patients had an esophageal or gastric perforation and 28 of 2453 (1.1%) patients required transfusion for bleeding. Forty-nine of 2453 (2%) patients developed a pneumothorax. Two of 2453 (0.1%) patients required a splenectomy. Conversion to the open procedure was necessary in 5.8% (143 of 2453) of patients. The laparoscopic approach is associated with minimal postoperative morbidity. Four of 2453 (0.2%) needed further early surgery for persistent bleeding, 11 of 2453 (0.4%) for a missed perforation, 22 of 2453 (0.9%) for crural disruption, paraesophageal herniation, or gastric volvulus. Four of 2453 (0.2%) patients died of either a missed duodenal perforation, a missed esophageal perforation, ischemic bowel with mesenteric thrombosis, or myocardial infarction. Early postoperative dysphagia occurred in 500 of 2453 (20.3%) patients. Late postoperative dysphagia occurred in 114 of 2068 (5.5%), with the need for dilatation in 72 of 2068 (3.5%). Endoscopy was required for food impaction in 11 of 2068 (0.5%) and re-operation for dysphagia occurred in 18 of 2068 (0.9%). Fifty-seven of 1658 (3.4%) patients developed reflux symptoms and 11 of 1658 (0.7%) required revisional surgery. Satisfaction rates ranged from 87 to 100%. In the short term, laparoscopic fundoplication can be performed with less morbidity and mortality than the open procedure. It is superior to medical therapy. Long-term follow-up is awaited.

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