Laparoscopic Nissen Fundoplication: Analysis of 162 Patients

Abstract

We aimed to evaluate the frequency of the need for proton pump inhibitor treatment following laparoscopic Nissen fundoplication (LNF) for gastroesophageal reflux disease (GERD). A total of 162 patients with GERD were treated surgically with LNF from October 2006 to March 2010 in our surgery department. Diagnoses were made by using upper gastrointestinal system (GIS) endoscopy and 24-hour pH monitoring, and all the patients underwent routine LNF surgery. The patients were questioned regarding complaints and proton pump inhibitor (PPI) usage during the postoperative period, and 40 patients who had postoperative GIS symptoms were included. Upper GIS endoscopy with antral biopsy for Helicobacter pylori (HP) identification and multichannel intraluminal impedance pH (MII-pH) monitoring were applied, and all the data were evaluated. The median postoperative follow-up time was 1.84 ± 0.850 (0.29–3.48) years. PPI treatment frequency was 37.5% (15 patients) in the 40 symptomatic patients, or 9.26% in all 162 patients who were operated on. The reason for PPI usage in 3 patients (7.5%) was regarded as recurrence. HP positivity was 67.5% in the symptomatic patients and 73.3% in the PPI treated group; 40% (6 patients) recovery was achieved in the HP (+) patients by using an HP eradication treatment protocol. The operated patients displayed statistically significant results in increased quality of life (P = 0.001) and lowered DeMeester scores (P = 0.000) during the postoperative period when compared with the preoperative period. LNF treatment for GERD prevents pathologic reflux in the long term and maintains symptomatic control, which leads to increased and better quality of life. PPI treatment alone during the postoperative period does not indicate “recurrence.” One of the most important reasons for recurrence is antral gastritis secondary to HP infection; PPI usage diminishes remarkably with an HP eradication protocol. MII-pH monitoring is an effective method of determining recurrences due to reflux and their types in postoperative symptomatic patients.