Abstracts
1999 Digestive Disease Week

# 2104 FIVE YEAR COMPREHENSIVE FOLLOW-UP OF LAPAROSCOPIC NISSEN FUNDOPLICATION.
M Anvari, St. Joseph's Hosp and McMaster Univ, Hamilton, ON Canada; C Allen, McMaster Univ, ON Canada

Laparoscopic Nissen fundoplication (LNF) has been shown to be an effective anti-reflux procedure by a number of short term follow-up studies. Longer follow-up is necessary to prove the effectiveness of this procedure. From August 92 to August 98, 566 patients with proven GERD and on long-term medication underwent LNF. Patients underwent a 24 hr pH recording, esophageal manometry, and symptom score assessment for six GERD symptoms preoperatively, and to date 430 patients have undergone repeat studies at 6 months 205 patients at 2 years and 55 patients at 5 years following LNF. Results: 15 patients (2%) have experienced recurrence of reflux symptoms, but only 6 have required repeat surgery. 5 redo fundoplications for recurrence were carried out successfully laparoscopically. The follow-up results at 6 months, 2 years and 5 years after surgery are tabulated below: Conclusions: Laparoscopic Nissen fundoplication remains an effective anti-reflux procedure at 5 years. It is associated with a low recurrence rate. Most recurrences are treated medically, although laparoscopic redo fundoplication is also very effective when necessary. In the majority of patients, there is no significant deterioration in the high pressure zone at LES, % reflux in 24 hrs, or symptom control between 6 and 24 and 60 months following the surgery, suggesting that the long-term results should be satisfactory.

	pre-op	6 months	2 years	5 years
% reflux in 24	9.3±0.42	post-op 1.3±0.14*	post-op 1.8±0.38*	post-op 1.0±0.30*
hr LES pressure	6.5±0.24	19.7±0.51*	18.0±0.76*	15.9±1.42*
(mmHg)
Symptom score	39.8±0.68	14.1±0.64*	16.6±1.07*	17.6±1.84*
values are given as meanSE, * p<0.0001 cf preop values

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