Complications and results of primary minimally invasive antireflux procedures: a review of 10,735 reported cases.

The number of antireflux procedures performed for gastroesophageal reflux disease in the United States has increased in the past decade. In a sampling of US hospitals by the National Center for Health Statistics, the number of patients discharged with the International Classification of Disease (ICD-9-CM) classification 44.66 (“Other procedures for creation of esophagogastric sphincteric competence,” ie, fundoplication) in the years 1988, 1993, and 1998 was 13,000, 22,000, and 40,000, respectively. It would be safe to say that the majority of these antireflux procedures are now minimally invasive. The trend for more laparoscopic antireflux procedures also has been seen in Europe. The current approach of choice for surgical treatment of gastroesophageal reflux disease is a minimally invasive transabdominal antireflux procedure. During this evolution of operational approach there have been untoward events associated with the minimally invasive antireflux operation. There is a growing need to audit the results of minimally invasive antireflux procedures because there has been (in the medical literature) a question of its efficacy, and also because of the development of novel endoscopic procedures to reproduce a sphincter mechanism in the lower esophagus, which potentially could compete with laparoscopic antireflux surgery. In this review the results of primary laparoscopic antireflux procedures will be examined (international experience, English-language literature) with an emphasis placed on the description of perioperative complications and primary procedure failures. Data on redo procedures also will be analyzed to determine the causes for failure of primary minimally invasive procedures. Recommendations for avoiding the complications and failure of the primary minimally invasive antireflux procedure will be described.