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/lp/american-medical-association/patient-satisfaction-following-laparoscopic-and-open-antireflux-K0u5Cnorkg
- Publisher
- American Medical Association
- Copyright
- Copyright © 1995 American Medical Association. All Rights Reserved.
- ISSN
- 0004-0010
- eISSN
- 1538-3644
- DOI
- 10.1001/archsurg.1995.01430030059011
- Publisher site
- See Article on Publisher Site
Abstract
Abstract Objective: To compare laparoscopic (LNF) with open Nissen fundoplication (ONF) in terms of hospital charges, efficacy, and patient satisfaction. Design: A prospective, nonrandomized study with a median follow-up of 370 days. Setting: Two tertiary care university hospitals. Patients: Eighty-six patients with complications of gastroesophageal reflux who had not had previous antireflux surgery were studied. Patients chose ONF or LNF following discussion with the surgeon; 12 underwent ONF and 74 underwent LNF, of whom eight required conversion to laparotomy. Main Outcome Measures: Hospital charges, disability, satisfaction, and side effects of fundoplication. Results: Patients were demographically similar. Total charges (mean±SD) for LNF ($11 673±$4723) were significantly less than for ONF ($18 394±$17 264). Patients who underwent LNF returned to work sooner (10±3 days) than those who underwent ONF (28±1 days). Bloating, dysphagia, and recurrent heartburn occurred with equal frequency in both groups. Recurrent reflux occurred in four of 74 LNF patients and one of 12 ONF patients. Overall satisfaction scores were similar, irrespective of operative technique (LNF, 3.35±0.87; ONF, 3.50±0.94. Conclusions: Laparoscopic Nissen fundoplication is as effective as ONF in the treatment of complications of gastroesophageal reflux disease and appears to cost less and lead to faster recovery from surgery, but does not result in higher patient satisfaction than ONF. The most important factor in patient satisfaction is the abolition of preoperative symptoms rather than the type of operation.(Arch Surg. 1995;130:289-294) References 1. Spechler SJ, Goyal RK. Barrett's esophagus . N Engl J Med . 1986;13:362-371.Crossref 2. Spechler SJ. Comparison of medical and surgical therapy for complicated gastroesophageal reflux disease in veterans . N Engl J Med . 1992;326:786-792.Crossref 3. Steiner CA, Bass EB, Talamini MA, Pitt HA, Steinberg EP. Surgical rates and operative mortality for open and laparoscopic cholecystectomy in Maryland . N Engl J Med . 1994;330:403-408.Crossref 4. Legorettta AP, Silber JH, Costantino GN, Kobylinski RW, Zatz SL. Increased cholecystectomy rate after introduction of laparoscopic cholecystectomy . JAMA . 1993;270:1429-1432.Crossref 5. Bittner HB, Meyers WC, Brazer SR, Pappas TN. Laparoscopic Nissen fundoplication: operative results and short-term follow up . Am J Surg . 1994;167: 193-198.Crossref 6. Cuschieri A, Hunter J, Wolfe B, Swanstrom LL, Hutson W. Multicenter prospective evaluation of laparoscopic antireflux surgery: preliminary report . Surg Endosc . 1993;7:505-510.Crossref 7. Dallemagne B, Weerts JM, Jehaes C, Markiewicz S, Lombard R. Laparoscopic Nissen fundoplication: preliminary report . Surg Laparosc Endosc . 1991;1:138-143. 8. Jamieson GG, Watson DI, Britton-Jones R, Mitchell PC, Anvari M. Laparoscopic Nissen fundoplication . Ann Surg . 1994;220:137-145.Crossref 9. Collard JM, deGheldere CA, DeKock M, Ottle JB, Kestens PJ. Laparoscopic antireflux surgery: what is real progress? Ann Surg . 1994;220:146-154.Crossref 10. Swanstrom L, Wayne R. Spectrum of gastrointestinal symptoms after laparoscopic fundoplication . Am J Surg . 1994;167:538-541.Crossref 11. Voyles CR. Reusable vs disposable laparoscopic instruments . Am Coll Surg Bull . 1993;76:38-40. 12. Donahue PE, Samuelson S. Nyhus L, Bombeck T. The floppy Nissen fundoplication: effective long-term control of pathologic reflux . Arch Surg . 1985; 120:663-668.Crossref
Journal
Archives of Surgery – American Medical Association
Published: Mar 1, 1995