[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.