Fatal and life-threatening complications in antireflux surgery: analysis of 5502 operations

Background: There have been few comprehensive studies relating to the life-threatening or fatal complications of antireflux surgery. Methods: Some 5502 antireflux operations were performed in Finland between January 1987 and January 1996 (population approximately 5 million); 3993 procedures (72.6 per cent) were open fundo-plications, 1162 (21.1 per cent) laparoscopic fundoplications and 347 (6.3 per cent) other anti- reflux procedures. Results: There were 43 fatal or life-threatening complications (prevalence 0.8 per cent). Twenty-two followed primary open fundoplication (prevalence 0.6 per cent), 15 laparoscopic fundoplication (prevalence 1.3 per cent) (P < 0.05), one refundoplication and five other antireflux procedures. The overall mortality rate was 0.3 per cent. Nine patients (0.2 per cent) died after open fundoplication, one (0.1 per cent) following laparoscopic fundoplication (P = 0.43), one following refundoplication and four after other antireflux procedures. Laparoscopic fundoplication was followed by 14 non-fatal life-threatening complications (prevalence 1.2 per cent), open fundoplication by 13 (prevalence 0.3 per cent) (P < 0.01) and other antireflux procedures by one life-threatening complication (0.3 per cent). Conclusion: Laparoscopic fundoplication was associated with more life-threatening complications than open fundoplication. This may compromise the advantages of the laparoscopic technique.