Outcomes in Open Nissen Fundoplication Compared with Laparoscopic Nissen Fundoplication in Adults with Antireflux Surgery

Background: Laparoscopic Nissen fundoplication (LNF) is regarded as the surgical treatment of first choice for refractory gastroesophageal reflux disease. It has generally been assumed that patients undergoing laparoscopic fundoplication will have less pain and a faster recovery. Initially there has been some question about whether the laparoscopic fundoplication would be as effective as the open fundoplication in the treatment of gastroesophageal reflux disease, therefore randomized studies comparing the two have focused on several points. These include symptomatic relief, complications, post-operative side effects and durability of symptom relief. Methods: A systematic search of the literature was conducted using Medline, Cochrane Database of Systematic Reviews (Evidence-based Medicine) and the Institute for Scientific Information Web of Science from January 2004 until February 2010 using terms: Gastroesophageal reflux and Nissen fundoplication or antireflux surgery or open Nissen fundoplication, randomized and outcomes. A manual search was performed using references from the articles retrieved and main review articles. Results: Six randomized studies met the inclusion criteria. Of these, several involved the compilation of data from the same cohort of patients at different follow-up times. All data gathered from a particular cohort of patients was treated as a single trial event. Results revealed there was a reduction of 2.63 days in the duration of hospital stay for the LNF group when compared to the ONF group. The average duration of hospital stay was 4.03 days in the ONF group. The pooled sick leave days were shorter in the LNF compared to ONF (19.81 versus 31.4 days). On the other hand, operating times were greater in the LNF group compared to the ONF group (94.6 versus 66 minutes). The conversion rate to open surgery in the laparoscopic arm was 7.71% (27 cases). Dysphagia was seen 6 months postoperatively, however long term results did not show significant dysphagia. Conclusion: Overall it was found that laparoscopic fundoplication reduced duration of postoperative hospital stay and decreased sick leave time and when compared to open group. The long term results confirmed that ONF and LNF are equally effective in controlling heartburn, regurgitation and dysphagia, with similar use of acid-suppressing drugs and patient satisfaction after surgery