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Neto et al. Laparoscopic Nissen fundoplication

Table 2: Current results for laparoscopic Nissen fundoplication in adults in series over 100 patients in the last 5 years
Author n Follow-up Outcomes Morbidity Mortality
Andolfi et al. [6] 176 17 months 88% symptom relieve Convertion rate 0.6% 0
Abdominal wall complications 1.7%
van Rijn et al. [46] 125 14-25 years 62% satisfaction NS NS
SarÄ et al. [47] 162 18 months 75% symptom relieve NS NS
9% postoperative medication usage
Warren et al. [48] 185 Minimum 12 89% satisfaction 2 cases of abscess linked to mesh hiatoplasty 0
months 12% postoperative medication 1 case of precocious revision due to
usage obstruction
Koetje et al. [49] 329 24 months Significant improvements Reoperation 7% NS
in symptom score and QOL
measurements
Teixeira et al. [50] 399 14 months 98% symptom relieve NS NS
Rossetti et al. [51] 301 56 months Significant improvement in QOL NS NS
Simorov et al. [52] 297 70 months 70% improvement in GERD Reoperation 0.9% NS
symptoms 5 bleeding
4 pneumothoraces requiring decompression
10 wound infections
3 prolonged ileus
8 urinary retention
Kellokumpu et al. [53] 249 10 years 98% symptom relieve Morbidity 7.6% 0
83% satisfaction
Qin et al. [54] 215 5.6 years 100% symptom relieve NS 0
Schietroma et al. [55] 178 Minimum 11 years 94% symptom relieve Conversion rate 6% 0
Beenen et al. [56] 222 11 years 87% satisfaction NS NS
Ross et al. [57] 510 Minimum 10 years 89% symptom relieve NS NS
NS: not stated; QOL: quality of life; GERD: gastroesophageal reflux disease

Nissen fundoplication may now be accomplished by
endoscope. [41] The technique is restricted to selected
cases, lacks hiatal closure and results are inferior to a
laparoscopic Nissen. Single port laparoscopy another
option for performinga fundoplication; [42] yet most
believe it brings solely cosmetic improvement with a
higher risk for complications. [43] The aid of a robot in the
operating room [44] does not bring any advantage to the
procedure and may add cost and time to the procedure.
More recently, the fundoplication has been replaced
by a magnetic chain of beads placed laparoscopically
around the distal esophagus. [45] Although good results
are shown, the drawback of foreign material in the
Figure 4: Fundoplication must be short-floppy and using gastric
fundus only hiatus precludes dissemination of the technology.

CONCLUSION Laparoscopic Nissen fundoplication continues to be
safe and provides excellent outcomes [Table 2], not
New antireflux therapies are currently available. only in experienced hands, but also these results may
Novel acid suppressant drugs and other classes of be reproducible in community hospitals as well, [58,59] if a
medication are available or under development. [37] proper preoperative workup, patient selection, surgical
However, up to now these medications have not technique and follow-up are observed [Figure 5].
shown clear advantages over current medication.
Surgical therapy is aimed at the pathophysiology of Financial support and sponsorship
the disease [38] and can be more effective than current Nil.
medical therapy. [39] Surgical procedures other than a
fundoplication; however, never gained acceptance for Conflicts of interest
uncomplicated GERD cases. This is with the exception
of bariatric procedures that control GERD and may There are no conflicts of interest.
be a good alternative to a fundoplication in obese
individuals. [40] Surgical technique has not changed Patient consent
expressively in the last several years; however, a There is no patient involved.
Mini-invasive Surgery ¦ Volume 1 ¦ March 31, 2017 9