Comparison of open and laparoscopic antireflux surgery for the treatment of gastroesophageal reflux disease in Taiwanese

Background and Purpose: Laparoscopic antireflux surgery has recently been introduced as an alternative to laparotomy for the treatment of gastroesophageal reflux disease (GERD) at National Taiwan University Hospital. This study compared the results of traditional open and laparoscopic fundoplication for the treatment of GERD. Materials and Methods: The surgical records and medical charts of 29 adult patients who were surgically treated for GERD between 1980 and 2001 were retrospectively reviewed. The clinical characteristics, indications for surgery, and surgical findings and procedures were analyzed. Results. Laparotomy and Nissen fundoplication were carried out on 20 of the patients between 1985 and 2000. Laparoscopic Nissen or Toupet fundoplication was performed on nine patients between 1997 and 2001. Patients in the laparoscopic group were younger than those in the laparotomy group (46.7 ± 15.9 vs 58.3 ± 18.5 yr). The incidence of associated prominent hiatal hernia was significantly higher in the laparotomy group (60 vs 33%). The mean operation time was 164.5 ± 25.5 minutes in the laparotomy group and 182.2 ± 52.2 minutes in the laparoscopy group (p = 0.6129). The mean hospital stay in the laparotomy group was significantly longer than that in the laparoscopy group (8.7 vs 3.4 days). Postoperative complications included three ventral hernias and one ileus in the laparotomy group. Results were good or excellent in 78.9% (15/19) of patients undergoing laparotomy (one patient was lost to follow-up 2 months later), and in 77.7% (7/9) of those undergoing laparoscopy. Symptomatic and endoscopic recurrence was recorded in two patients in the laparotomy group and one in the laparoscopy group. Conclusion: Laparoscopic fundoplication is as effective as traditional laparotomy for treating GERD. More GERD patients in Taiwan, even the young and those without associated hiatal hernia, would rather undergo the less invasive and cosmetically better laparoscopic surgery than require medication throughout their lives.