Yonsei Med J.  2009 Feb;50(1):89-94. 10.3349/ymj.2009.50.1.89.

Laparoscopic Nissen Fundoplication in Korean Patients with Gastroesophageal Reflux Disease

• Lee SK
• Kim EK

• KMID: 1782973
• DOI: http://doi.org/10.3349/ymj.2009.50.1.89

Abstract

PURPOSE
Although the prevalence of gastroesophageal reflux disease (GERD) is relatively low in Korean population, the number is increasing. The aim of this study is to analyze our experience with laparoscopic Nissen fundoplication.
PATIENTS AND METHODS
From Sep. 2003 to Mar. 2008, 31 adult Korean patients diagnosed with GERD underwent laparoscopic Nissen fundoplication. A 360degrees fundoplication was carried out in all patients.
RESULTS
There were 19 males and 12 females with an average age of 46.8 +/- 17.0 years. Typical symptoms were present in 15 (48%) of patients, and atypical symptoms in 16 (51.6%). Both typical and atypical symptoms were present in 4 of patients (12.9%). Preoperative studies showed hiatal hernias in 13 patients (41.9%), Barrett's esophagus in 10 (32.3%), and reflux esophagitis in 18 (58.1%). Mean DeMeester score was 17.4 +/- 16.7, mean operative time 206.1 +/- 47.8 min and mean hospital stay 5.2 +/- 2.1 days. Perioperative complications occurred in 5 patients (16.1%), including gastric perforation, subcutaneous emphysema, atelectasis, and prolonged ileus. Gastroesophageal junction stenoses with subsequent endoscopic balloon dilations were required in 5 patients (16.1%). After surgery, symptoms were completely controlled in 17 patients (54.8%), partially improved in 12 patients (38.7%) and not controlled in 2 patients (6.5%).
CONCLUSION
In our series, 93.5% of patients had either complete or partial remission of symptom after laparoscopic Nissen fundoplication. Atypical symptoms were more predominant in our Korean patients. Laparoscopic Nissen fundoplication is an efficacious method of controlling symptoms of GERD, even for those who have atypical symptoms.

Keyword

Gastroesophageal reflux disease; laparoscopy; fundoplication; Koreans

MeSH Terms

Adult
Female
Follow-Up Studies
*Fundoplication
Gastroesophageal Reflux/ethnology/*surgery
Humans
Korea
*Laparoscopy
Male
Middle Aged
Patient Satisfaction
Prevalence
Treatment Outcome

Figure

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  Fig. 1 Position of trocars for laparoscopic Nissen fundoplication.

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  Fig. 2 Schema of completed Nissen fundoplication.

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  Fig. 3 Narrowing of esophagogastric junction due to complete fundoplication causing dysphagia (A). After 2 sessions of endoscopic balloon dilation, esophagogastric junction narrowing was resolved, and dysphagia was relieved (B).

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