Long-term Outcome of Laparoscopic Fundoplication for Gastroesophageal Reflux Disease in Japanese Patients

Fumiaki Yano, MD, Nobuo Omura, MD, Kazuto Tsuboi, MD, Masato Hoshino, MD, Yoshio Ishibashi, MD, Katsunori Nishikawa, MD, Yujiro Tanaka, MD, Hideyuki Kashiwagi, MD, Katsuhiko Yanaga, MD. Department of Surgery, Jikei University School of Medicine


Introduction: Laparoscopic fundoplication (LF) is an established surgical treatment for gastroesophageal reflux disease (GERD). However, since the number of surgeries in Japan is much lower than that in western countries, reports on the long-term outcome of surgical treatment are limited. In this study, long-term outcomes of LF for GERD at a single institution in Japan was evaluated.
Methods: Three-hundred and fifty patients underwent LF for GERD to date. Among them, 112 patients who have been followed-up for more than 10 years were studied. There were 64 men (57%) and 48 women (43%). Their mean age was 53.3 (range, 18-85) years. Their clinical data were collected in a prospectively fashion and retrospectively reviewed. Long-term outcome was assessed in terms of operative procedure, peri- and post-operative complications, and recurrence rate after surgery. Recurrence was defined as post-operative recurrence of erosive esophagitis and/or evident hiatal hernia.
Results: No operative mortality occurred. The mean follow-up period was 143.7 (range 120-198) months. Nissen procedure was performed for 62 patients (55%), Toupet procedure for 48 patients (43%), and the others 2 (2%) underwent Collis-Nissen procedure. A total of 20 peri-operative complications were observed in 20 patients (18%), consisting of bleeding mainly from the spleen (10%), and injuries of the vagus nurve (2%), stomach (2%), crus of the diaphragm (2%), esophagus (1%), or mediastinal pleura (1%), but no one required conversion to open surgery. Post-operatively, 11 patients (10%) complained of moderate to severe post-operative dysphagia and 2 patient (2%) required re-do surgery (Nissen to Toupet). Recurrence was diagnosed in 12 patients (11%), and 3 of them (3%) required re-do surgery. The other 9 patients (8%) were treatable with acid suppressive medications. The mean time to recurrence was 67.0±54.0 (range 10-158) months. Three patients each recurred by 2 years, 2 to 5 years, and 5 to 10 years, respectively, while 2 patients recurred more than 10 years after surgery. As patterns of recurrences, 7 patients had sliding hiatal hernia with erosive esophagitis, 3 patients had a disrupted fundoplication, and 2 patients had paraesophageal hiatal hernia.
Conclusion: Long-term non-recurrence rate of LF were 89%. LF is a safe and secure procedure for treatment of GERD.

Session Number: Poster – Poster Presentations
Program Number: P186
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