What is the long-term efficacy of laparoscopic Nissen fundoplication?

The treatment of GERD usually entails either PPIs or surgery. It has been reported that 62% of patients who have undergone laparoscopic Nissen fundoplication used PPIs at long-term follow-up, and this finding has raised concerns about the durability of such surgery. In this Practice Point commentary, I discuss the findings and limitations of a study by Oelschlager et al., which reported the long-term (≥66 months) follow-up data of 228 of 441 patients who underwent laparoscopic fundoplication at their institution. Control of heartburn and regurgitation was achieved in more than 90% of patients, with a low rate of adverse effects and subsequent repeat surgery, and an excellent overall outcome. PPIs were used by 23% of patients at long-term follow-up, similar to most other reports. However, 35% of the original cohort was lost to follow-up. It has been reported elsewhere that the apparent outcome for antireflux surgery is influenced by the completeness of follow-up, but other reports of 10-year outcomes with near-complete follow-up describe similar success. Oelschlager et al.'s data, and other reports, show that a good long-term outcome is achieved in ∼90% of patients who undergo laparoscopic Nissen fundoplication for GERD.