Laparoscopy is regarded as surgical treatment of first choice for refractory gastroesophageal reflux disease by many surgeons based on several short- and mid-term studies.
The long-term efficacy of Nissen fundoplication, however, is still questioned as objective data gathered from prospective studies are lacking.
Dr Werner Draaisma and colleagues assessed the outcomes of laparoscopic vs conventional Nissen fundoplication up to 5 years after surgery.
The investigative team conducted a multicenter randomized controlled trial from 1997 to 1999.
The team randomized 177 patients to undergo laparoscopic or Nissen fundoplication.
At 5 years after surgery, all patients were requested to fill in questionnaires, and to undergo esophageal manometry, and 24-hour pH-metry.
The team reported that a total of 148 patients agreed to participate in the follow-up study.
|Total esophageal acid exposure time was 2% for both techniques|
|Annals of Surgery|
Of these, 79 patients underwent laparoscopy, and 69 underwent Nissen fundoplication.
Also of the 148 patients, 97 patients consented to undergo esophageal manometry, and 24-hour pH-metry.
At 5 years follow-up, 20 patients had undergone reoperation: 12 after laparoscopic, and 8 after Nissen fundoplication.
The investigators observed no difference in subjective outcome, with overall satisfaction rates of 88% and 90%, respectively.
Total esophageal acid exposure times were about 2% for both techniques.
Antisecretory medication was taken daily in 14% and 16%, respectively.
There was no correlation between medication use and acid exposure and indices of symptom-reflux association.
The team noted no significant differences between subjective and objective results at 3 to 6 months, and results obtained at 5 years after surgery.
Dr Draaisma's team commented, “The effects of laparoscopic and Nissen fundoplication on general state of health and objective reflux control are sustained up to 5 years after surgery.”
“The long-term results of laparoscopic and Nissen fundoplication are comparable.”
"A substantial minority of patients in both groups had a second antireflux operation or took antisecretory drugs, although the use of those medications did not appear to be related to abnormal esophageal acid exposure."