Laparoscopic Nissen fundoplication.

Laparoscopic Nissen fundoplication represents a minimally invasive surgical approach to symptomatic gastroesophageal reflux and may offer patients an attractive alternative to indefinite medical therapy. Fourteen patients with persistent gastroesophageal reflux and two with severe achalasia underwent a laparoscopically guided 360-degree or Nissen fundoplication. Both individuals with achalasia also had an extended distal esophagomyotomy. Two patients required conversion to open laparotomy because of difficulties in defining the anatomy of the posterior esophagus. All 16 patients reported complete relief of their symptoms. The average length of hospital stay was four days. These early results of laparoscopic Nissen fundoplication are encouraging and hopefully will stimulate further experience in this area.