Laparoscopic Nissen Fundoplication in Lung Transplant Recipients
Abstracts
|
Gastroesophageal reflux disease (GERD) with pulmonary aspiration in lung transplant patients has recently been implicated as a potential factor in pulmonary allograft dysfunction. Laparoscopic Nissen fundoplication can correct GERD and may benefit lung transplant recipients. The present study analyzes the characteristics of the surgery in this high-risk population. Methods: We reviewed the records of 35 lung transplant patients who underwent laparoscopic Nissen fundoplication at Duke University Medical Center between June 1997 and November 2001. Surgical therapy was undertaken following gastric pH and esophageal manometry results as well as patient-reported symptoms consistent with reflux. Patients with concurrent pyloroplasty (7) or open laparotomy for intra-abdominal pathology (3) at the time of surgery were excluded from the study, resulting in a total of 25 (6 single and 19 bilateral) lung transplant patients. Results: Sixteen males and 9 females were included in the study. Average patient and surgical characteristics were as follows: Age- 44 years (range 16 - 67); Period between transplant and laparoscopic Nissen- 20 months (range 2 - 84); Estimated blood loss- 72 cc (range 5 - 150, 23 patients); Post-surgical hospital stay- 4 days (range 1 - 18). There was no intra-operative or peri-operative mortality from the anti-reflux surgery. Of note is that 21 of the 25 (84%) lung transplant patients undergoing laparoscopic Nissen fundoplication were found to have hiatal hernias at the time of operation. Following discharge, 6 patients were readmitted within 30 days (pneumonia, 3; acute rejection, 1; pancreatitis, 1; nausea/vomiting, 1). The majority of patients experienced post-fundoplication improvement or stabilization of their pulmonary function within the initial months following laparoscopic Nissen. This high-risk population tends to require longer peri-operative hospital stays than non-transplant patients for optimization of their pulmonary condition and anti-rejection medications. Conclusions: In our experience, laparoscopic Nissen fundoplication can be safely used as treatment for GERD in lung transplant recipients. The procedure is associated with minimal complications and no intra- or peri-operative mortality. Pulmonary function may be improved or stabilized in most patients following fundoplication. The average hospital stay is longer in this population due to their multiple medical problems. |
