Laparoscopic fundoplication for GERD offers lasting benefits.
"Laparoscopic Nissen fundoplication should be regarded as the surgical procedure of choice for patients with refractory gastroesophageal reflux disease because its durable, long-term outcome is similar to conventional surgery, and because medication use does not increase with time," Dr. Werner A. Draaisma said at the 13th United European Gastroenterology Week.
A second report, published in October, also documented the long-term durability of laparoscopic fundoplication in more than 1,000 patients, but this study did not involve a direct comparison between the laparoscopic approach and conventional, open surgery.
The head-to-head comparison initially involved 177 GERD patients who were refractory to all medical therapy. They were randomized to Nissen fundoplication by either the laparoscopic or conventional approach at nine Dutch hospitals during 1997-1999 (Lancet 2000;355:170-4).
Of the 177 patients, 79 had laparoscopic treatment and 69 had conventional treatment; these patients were available for follow-up analysis. The other 29 patients either withdrew from the study, never underwent surgery, or were lost to follow-up. Data on both subjective and objective measures of treatment success were available for 97 patients. Subjective measures only were available for another 51 patients.
After at least 5 years of follow-up, all of the subjective measures of outcome were similar in the two treatment groups, including quality of life scores. Satisfaction with the outcome was reported by 87% of patients who had the laparoscopic procedure and by 90% of those who had conventional surgery, reported Dr. Draaisma, a surgeon at the University of Utrecht, the Netherlands.
Surgical reinterventions were needed by 12 of the 79 laparoscopic patients (15%) and by 8 of the 69 conventional surgery patients (12%).
Total esophageal acid exposure time with a pH of less than 4, measured after 5 years, was 2% in both study groups. The acid exposure time was reduced by about 80% in all patients, and this effect was sustained during follow-up. Daily medications for reflux, mainly proton pump inhibitors, were used by 16% of conventional surgery patients and 14% of laparoscopic patients; the difference was not significant.
The second report, from a team of French researchers, discussed 2,684 patients who had undergone laparoscopic fundoplication for refractory reflux disease at 31 centers in France during 1992-1998 (Arch. Surg. 2005;140:946-51). Long-term follow-up for 5 or more years was available for 1,340 patients.
At follow-up, the residual rate of severe dysphagia was 5.1%. Further surgery was needed by 4.4% of patients. The rate of recurrent reflux was 10.1%, and 9.1% of patients required antisecretory medication. Gas-bloat syndrome was seen in 7.5% of patients.
Overall, 93% of patients were satisfied with the long-term outcome of their surgery. The researchers concluded that long-term follow-up showed that laparoscopic fundoplication was an effective procedure for treating reflux.
BY MITCHEL L. ZOLER
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|Title Annotation:||News; gastroesophageal reflux disease; laparoscopic Nissen fundoplication|
|Author:||Zoler, Mitchel L.|
|Publication:||Internal Medicine News|
|Date:||Feb 1, 2006|
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