The objective of the present study is to present the complications that occurred in 600 consecutive patients with gastroesophageal reflux disease who underwent laparoscopic fundoplication. A Nissen-Rosetti procedure (360° fundoplication) was performed in 587 patients (97.8%) and a Toupet procedure (270(0) fundoplication) in 13 (2.2%). Eighty- one patients were also subjected to a concurrent cholecystectomy and one patient a concurrent cervical pharyngoesophageal diverticulectomy with cricopharyngeal myotomy. Thirty-nine patients had a previous upper abdominal operation. The period of hospitalization varied from 12 hours to 23 days, with an average of 1.2 days. The operation was converted to an open procedure in 10 patients (1,7%). The main cause of conversion was the presence of adhesions. The most frequent intraoperative complication was pneumothorax, that was observed in eight patients. All pneumothoraces occurred in the first 100 cases. Five patients had significant operative bleeding; two of them required laparotomy for bleeding control. Gastric ulcer was diagnosed in seven patients. One alcoholic patient died of acute pancreatitis and other with gastric perforation of multiple organ failure syndrome. Other major complications were two intrabdominal abscesses, one esophageal perforation, one sepsis due to gastric perforation, one hemorrhagic shock, and one gastric obstruction due to fundoplication herniation. It is concluded that complications of laparoscopic fundoplication are low and decrease significantly with the surgeon's experience.
Fundoplication; Antireflux operation; Laparoscopy; Gastroesophageal reflux; Reflux esophagitis; Gastric perforation