Laparoscopic Nissen Fundoplication for Gastroesophageal Reflux Disease: A Retrospective Study of 50 Consecutive Cases

Background: Laparoscopic anti-reflux surgery has been proven to be an effective treatment for gastroesophageal reflux disease (GERD) in Western countries. On the other hand, the concept of surgical treatment of GERD has not widely spread in Japan, and the number of operations performed remains extremely low. Purpose: The aim of this study is to analyze our initial experience with laparoscopic Nissen fundoplication. Patients and Methods: From August 2010 to November 2012, consecutive 50 adult patients diagnosed with GERD underwent laparoscopic Nissen fundoplication. There were 42 men and 8 women, with an average age of 45.6 ± 15.9 years. All patients were resistant to medical treatment for GERD. Pre-operative endoscopy showed hiatal hernias in 47 patients (94%), and Barrett’s esophagus in 26 patients (52%). In regard to mucosal change of the lower esophagus, 38 patients (76%) were diagnosed as non-erosive gastroesophageal reflux disease (NERD) and the remaining 12 patients (24%) as reflux esophagitis (RE). Results: Laparoscopic approach was successfully done in all patients without conversion. Mean operative time was 105.9 ± 22.7 min with mean blood loss of 6.5 ± 13.1 ml, and mean post-operative hospital stay was 2.0 ± 0.2 days. There was no intra-operative complication and no mortality. There were 4 post-operative complications in 4 patients (8%) during the mean follow-up period of 4.7 ± 5.5 months. The change in GERD symptoms was evaluated using FSSG (frequency scale for the symptoms of GERD) at each visit. The average total score was 24.0 ± 10.2 before surgery and significantly dropped to 8.4 ± 7.0 at 6 months after surgery (p<0.05). PPIs were prescribed in 43 out of 50 patients (86%) before surgery and the percentage dropped to 8.7% (4 out of 46 patients) at the latest visit. Overall efficacy rate was 90%. Conclusion: Laparoscopic Nissen fundoplication for medically uncontrolled GERD is safe and effective also in the Japanese population. Considering the recent rapid increase of obesity and westernized life style, the necessity of the treatment will be more and more important.