Long-Term Outcomes of Laparoscopic Fundoplication for Gastroesophageal Reflux Disease in Japanese Patients

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

Introduction: The laparoscopic fundoplication (LF) is an accepted surgical treatment for gastroesophageal reflux disease (GERD). However, since the number of surgeries in Japan is much lower than that of in western countries, reports on the long-term outcomes of surgical treatment are limited. In this study, long-term outcomes of LF for GERD at a single institution in Japan were evaluated.
Methods: Two-hundred and seventy-six patients underwent surgical treatment of LF for GERD to date. Among them, 42 patients were followed-up for more than 10 years were studied. There were 24 men (57%) and 18 women (43%). Their mean age was 51.3 (range, 18-81) years. Their clinical data collected in a prospectively fashion was retrospectively reviewed. Long-term outcomes were assessed in terms of operative procedure, peri- and postoperative complications, and recurrence rate after surgery. Recurrence was defined as postoperative recurrence of erosive esophagitis and/or evident hiatal hernia.
Results: No operative mortality occurred. The mean follow-up was 133.4 (range 121-171) months. Nissen procedure was performed for 24 patients (57%) and the others (43%) underwent Toupet procedure. A total of 7 perioperative complications were observed in 7 patients (17%), consisting of bleeding mainly from the spleen (12%), and injuries of the esophagus (2.5%) or stomach (2.5%), but no one required conversion to open surgery. Five patients (12%) complained moderate to severe postoperative dysphagia and one patient (2%) required re-do surgery (Nissen to Toupet). Recurrence was diagnosed in 7 patients (17%), and 2 of them (5%) required re-do surgery. The other 5 patients (12%) were treatable with acid suppressive medications. The mean time to recurrence was 58.9±43.7 months. Two patients each recurred by 2 years, 2 to 5 years, and 5 to 10 years, respectively, while only 1 patient recurred more than 10 years after surgery. As patterns of recurrences, 4 patients had sliding hiatal hernia with erosive esophagitis, 2 patients had paraesophageal hiatal hernia, and 1 patient had a disrupted fundoplication.
Conclusion: Long-term non recurrence rate of LF were 83%. LF is a safe and secure procedure for treatment of GERD.