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David W. Rattner, MD; David C. Brooks, MD

Arch Surg. 1995;130(3):289-294.

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)

Author Affiliations
From the Departments of Surgery, Massachusetts General Hospital (Dr Rattner) and Brigham and Women's Hospital (Dr Brooks); and Harvard Medical School (Drs Rattner and Brooks), Boston.

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