Changing surgical principles for gastro-oesophageal reflux disease--is laparoscopic fundoplication justified in the light of surgical complications?

Morbidity and mortality after surgical treatment for gastro-oesophageal reflux disease (GORD) can be considerable. During the past decade the dynamic evolution of laparoscopic surgery has seen this technique applied for GORD. In this chapter I will discuss perioperative and postoperative morbidity and mortality. I base my remarks on publications from all over the world, a national questionnaire, and a restricted national register. Only one randomised study has been reported, which concluded that there was no difference between conventional open and laparoscopic operations. A number of non-randomised studies have reported complications and clinical results in the same range as previously reported after open operations. More than half the surgical units in Sweden do laparoscopic fundoplications. In the questionnaire complications were reported in >2%, but the mortality was extremely low, <0.2%. These complications included postoperative paraoesophageal herniation, perforations, and reoperations for other reasons. There is a learning curve before complication rates are reduced.