Background: Reflux recurrence is the most common long-term complication following fundoplication. Its frequency was independent from the type of fundoplication in randomized studies. Results for different techniques of laparoscopic antireflux surgery were retrospectively compared after ten years.
Methods: From 1992 to 1997, 120 patients had primary laparoscopic fundoplication with a ‘tailored approach’ (type of wrap chosen according to esophageal peristalsis): 88 received a Nissen-, 22 an anterior, and 10 a Toupet-fundoplication. Follow-up of 87% of the patients included disease related questions and the gastrointestinal quality of life index (GIQLI).
Results: 89% of patients would select surgery again. Heartburn was reported by 30% of the patients independent of the type of fundoplication. Regurgitations were noted from 15% of patients after a Nissen, 44% after anterior fundoplication, and 10% after a Toupet (p=0.04). 28% were on acid suppression therapy again. Proton pump inhibitors were less frequently used following Nissen-fundoplication (p=0.01). The GIQLI was 110 ± 24 without significant differences for the type of fundoplication.
Discussion: Ten years after laparoscopic fundoplication, overall results are satisfactory. A quarter of the patients are on acid suppression therapy. Nissen fundoplication appears to control reflux better than a partial fundoplication.