Laparoscopic gastric fundoplication for treatment of gastroesophageal reflux disease (GERD). Results from 150 consecutive cases.

Gastroesophageal reflux disease (GERD) is common and often not adequately managed with lifestyle changes and medication. Laparoscopic gastric fundoplication has widely been accepted as the mainstay in surgical treatment for patients who fail medical management. We present a review of 150 consecutive patients with symptoms of failed medical management of GERD who were operated on at a community hospital. Patients received either a 360 degrees wrap (Nissen Fundoplication) or a 270 degrees wrap (Toupet) and, if warranted, a repair of a hiatal hernia. Thirty-nine percent of the patients were discharged on the first postop day, and another 47% were discharged on the second postop day. Heartburn and coughing were completely eliminated in 90% of patients and reduced to a level that was well tolerated in all but three patients. Some dysphagia, early satiety, and bloating were typical in the immediate postop period but were generally minor and improved substantially in the first 4 to 8 weeks. Six percent of patients had some complication, some severe and requiring reoperation, but all resolved. Eighty-five percent of the patients stated that the outcomes was either "perfect" or "much better." Laparoscopic gastric fundoplication for treatment of chronic GERD is an excellent option for patients who have medically uncontrolled reflux symptoms.