[Should the laparoscopic approach be avoided in a Nissen fundoplication procedure?].

OBJECTIVE

A recently published trial concludes that the recurrence of GER by laparoscopic fundoplication (LF) is higher than by open surgery (OF) modifying their informed consent and the surgery approach.

Objective

To analyze our results to assess changing clinical practice where the laparoscopy is the approach of choice.

MATERIAL AND

METHODS

Retrospective study of patients undergoing laparoscopic fundoplication between 2010-2015. The same criteria of the reference clinical trial were applied in the collected data and recurrence criteria.

RESULTS

56 patients were operated. Our patients were comparable on sex and neurological injury to those of the study. Our average follow-up was 2.6 years (0.07-6.3). During the monitoring period there were five recurrences. The relative risk (RR) of failure in the LF group was 4 times higher than ours (RR 4.19; 95% CI, 1.66-10.5). Our survival was 90% per year. Multivariate analysis was performed (Cox regression controlling neurological injury, esophageal atresia and after gastrostomy). Neurological injury (p= 0.01) was the only risk factor for recurrence.

CONCLUSION

A clinical trial is not enough to change clinical practice, but it motivates further studies. According to our review, the results suggest no increased risk of recurrence with laparoscopy but long-term monitoring is necessary.