A team from the USA conducted a retrospective review of patients who underwent laparoscopic anti-reflux operations to assess the management and outcome of complications.
A total of 538 patients who underwent operation from 20 January 1993, through 28 December1999, were looked at.
The outcome measures were complications defined as any major or minor deviation from the standard postoperative clinical pathway.
|Major complications in laparoscopic antireflux surgery are rare.
|Archives of Surgery
Minor complications did not require invasive treatment, and were not expected to result in permanent disability.
Major complications required invasive treatment or could result in permanent disability.
The frequency of complications was also stratified into those that occurred during primary anti-reflux procedures and those that occurred during re-operations for previously failed procedures.
The results revealed that 92 complications occurred in 538 operations (17.1%).
68 patients (12.6%) experienced minor complications. Postoperative ileus was the most common complication (6.9%), followed by pneumothorax (2.4%), and urinary retention (1.9%).
Major complications were present in only 24 patients (4.5%) and occurred significantly more frequently after re-operations. Of these, dysphagia was the most frequent complication observed (2.0%), followed by perforated viscus (0.7%). Two patients died. All but 4 major complications resulted in full recovery.
Dr Dieter Pohl of the Roger Williams Medical Center, Providence, Rhode Island, concluded, "Major complications in laparoscopic antireflux surgery are rare, their treatment is straightforward, and permanent disability is uncommon.
"Complications occur twice as often during re-operations, highlighting the difficulty in performing these procedures. Although primary laparoscopic antireflux operations are performed by many general surgeons routinely, re-operations should be performed by a team experienced in laparoscopic esophageal surgery."