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departments > general surgery > laparoscopic fundoplication

Results

Operative complications, conversion rate, postoperative morbidity and mortality
Perdikis et al. reviewed 23 papers including own data and published results and operative complications, conversion rate, postoperative morbidity and mortality from 2453 patients reported.

The most common complication was the development of a pneumothorax in 2% of the patients. This huge number of laparoscopic fundoplications showed a one-percent rate of gastric or esophageal perforation. Perforation resulted in about 50% conversion to the open procedure. Bleeding requiring blood transfusion occured in 1.1% of patients, and 0.8% had to be converted to the open procedure for this reason. Splenic injury, which occurs in up to 8.5% of open Nissen fundoplications, is a very uncommon problem for the laparoscopic procedure. The overall conversion rate was 5.8%, but is significantly less with increasing experience.
Postoperative problems are usually few and mild. The commonest reported postoperative morbidity are of pulmonary nature and occur in about 2.5%. Wound complications were reported in 1% of all cases, and ileus occured in just 0.5%. Very uncommon is the development of an intra-abdominal abscess, which is found in 0.08%. Deep vein thrombosis and pulmonary embolus were rarely reported. Other sporadic complications include severe pancreatitis and explosive incapacitating diarrhea. There have been very few mortalities after laparoscopic fundoplication. Causes include postoperative myocardial infarction, esophageal perforation, duodenal perforation and ischemic bowel associated with mesenteric thrombosis. The overall incidence appears to be close to 0.2% compared to an incidence closer to 1% for the open procedure.

Early postoperative symptoms

The most common early postoperative problem after Nissen fundoplication is dysphagia (23%). Early dysphagia is less common after the Toupet fundoplication (16%-20%) (12, 14). Other typical symptoms after both techniques are bloating (4%), chest pain (3%), diarrhea (1%), salivary regurgitation (1%) and nausea (1%). Most of them do not require therapy and will improve within the first 3 months after surgery.
Long term outcome
Postoperative reflux symptoms are reported in 3.4%. Most patients have mild symptoms not warranting aggressive medical therapy, however 0.7% had redo surgery for reflux symptoms. Recurrent reflux following the laparoscopic Toupet fundoplication is reported by some to be very high . Postoperative late dysphagia occurs in 5.5% of patients, most with mild symptoms. 3.5% required dilatation because of dysphagia, and for persistent dysphagia and 0.9% needed resurgery. An endoscopy for food impaction is reported in 0.5%. Dysphagia after the Toupet fundoplication is reported to be less common than after the Nissen fundoplication.
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