Indications, benefits and outcome of laparoscopic Nissen fundoplication

The advent of laparoscopic fundoplication has catalyzed renewed interest in the surgical treatment of gastroesophageal reflux disease (GERD), and continues the evolution of surgical treatment begun by Phillip Allison in the early 1950s. Clinical observations of the natural history of GERD suggest a high-risk group of approximately 25% of patients who develop recurrent and progressive disease, often despite medical therapy. These patients should be considered candidates for early surgical intervention. Early clinical studies of laparoscopic fundoplication document successful relief of reflux symptoms in nearly 90% of patients, results nearly identical to its open counterpart. This review focuses on the indications and patient selection for, as well as the technique and outcome of laparoscopic Nissen fundoplication.