LAPAROSCOPIC NISSEN FUNDOPLICATION: TECHNIQUE AND PRELIMINARY RESULTS

Laparoscopic Nissen fundoplication is positioned to become the standard of surgical treatment for patients with 
gastroesophageal reflux disease (GERD). The present study aimed to evaluate in a prospective manner the technique and the clinical results of laparoscopic Nissen fundoplications. Between January 1998 and January 2001, 28 patients (17 male and 11 female with a mean age 42 ± 6.7 years) who had undergone a laparoscopic approach for a Nissen fundoplication in El-Minia University Hospital were studied. All patients had undergone medical treatment for at least 3 months and then were referred to surgery due to unsatisfactory symptom control in 19 patients (67.8%) or to avoid life long medications in 9 patients (32.2%). Laparoscopic Nissen fundoplication was done with or without division of short gastric vessels. It was successful in 24 of 28 patients (85.7%). The mean operative time was 126 ± 12.4 minutes. The mean post operative hospital stay was 3.1 + 0.2 days. Conversion from laparoscopic to open fundoplication was needed in 4 cases (14.3%). There was no operative mortality with low serious morbidity. The mean heartburn score was 2.68 ± 1.26 before operation versus 0.35 ± 0.79 after operation by one year, with significant improvement (P<0.01). The mean preoperative dysphagia score was 1.1 ± 0.9 versus 0.32 ± 0.21 by one year postoperatively (P<0.01). Troublesome dysphagia was reported in 10 patients (35.7%), one was reoperated upon and 9 cases responded to dilatation or diet management. 
Conclusion: Laparoscopic Nissen fundoplication is a promising technique because it is safe with low morbidity rate and 
short hospital stay. The short term functional results shows the effectiveness of the technique in controlling the 
gastroesophageal reflux disease. Long term results should be studied.