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Modified Nissen Fundoplication: Operative Technique and Its Impact on Immediate Postoperative Complications
Daniela Diaz Calderon*, Rodrigo Y. Adame, Edgar NúñEz, Beatriz De Rienzo, Juan F. Molina-Lopez, Cesar Decanini
Minimally Invasive Surgery, American British Cowdray Medical Center, Alvaro Obregon, Mexico
OBJECTIVE: The pathophysiology and treatment of gastroesophageal reflux disease has undergone significant changes over the last decade. The aim of this study was to describe a modified Nissen fundoplication technique and review the outcomes of a large single-surgeon experience.
METHODS: Retrospective review of patients who underwent modified Nissen fundoplication from 2008 to 2013 by a single surgeon, and comparison of immediate postoperative results (up to 3 months) with those obtained from a comprehensive review of the literature. Patients were evaluated at 1 week, 1 month, and 3 months postoperative.
RESULTS: 568 patients (300 men; mean age of 45 [range, 13-76] years) underwent modified Nissen fundoplication (figure). The median operative time including intraoperative endoscopy was 75 (range, 45-130) minutes. Median length of hospital stay was 2 (range, 2-4) days. No intraoperative complications occurred. Compared to the results obtained from a comprehensive literature review, patients who underwent modified Nissen fundoplication had significantly less bloating (P<0.001), persistent postoperative reflux (P=0.01), heartburn (P=0.005), dysphagia (P<0.001), and wrap migration (P<0.001) (table). No significant differences were seen in wrap rotation (P=0.55) or short-term redo fundoplications. Patients who underwent fundoplication with a 60Fr Savary-Gilliard dilator had significantly less dysphagia compared to patients in whom a 58Fr dilator was used (4.7% vs. 1%, P=0.018).
CONCLUSION: Modified laparoscopic Nissen fundoplication with intraoperative endoscopy is associated with very low morbidity, and compared to results obtained from a current literature review, it results in significantly less immediate postoperative complications. | Current Study | Literature Review | P value | | (n=568) | (n=562) | | | Bloating (%) | 1.2 | 9.1 | <0.001 | | Persistent Reflux (%) | 0.5 | 2.3 | 0.01 | | Heartburn (%) | 1.4 | 0 | 0.005 | | Dysphagia (%) | 1.6 | 16.9 | <0.001 | | Wrap migration (%) | 0.2 | 3.6 | <0.001 | | Wrap rotation (%) | 0.2 | 0.4 | 0.55 | | Redo Fundoplication (%) | 0.7 | 0 | NS | | | | |
NS: non-significant. 
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