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Comparative Study
. 1999 Apr-Jun;3(2):103-6.

Early laparoscopic Nissen fundoplication for recurrent reflux esophagitis: a cost-effective alternative to omeprazole

S C Nessen  1 , J Holcomb, B Tonkinson, S P Hetz, M A Schreiber
Affiliations
Comparative Study

Early laparoscopic Nissen fundoplication for recurrent reflux esophagitis: a cost-effective alternative to omeprazole

S C Nessen et al. JSLS. 1999 Apr-Jun.

Abstract

Background: Eighty percent of patients treated medically for gastroesophageal reflux disease relapse after treatment. Many of these patients require indefinite treatment with omeprazole to prevent recurrence. Nissen fundoplication has been shown to be effective, safe and cost effective in the management of gastroesophageal reflux disease. We suggest a treatment algorithm, which encourages early surgical intervention in cases of recurrent esophagitis after a previously successful two-month course of omeprazole.

Methods: We have offered laparoscopic Nissen fundoplication since 1993. Patients who received Nissen fundoplication since 1990 were asked to report return to baseline activity, medications, and lifestyle changes. Concurrent chart review of patients treated with omeprazole was conducted to analyze cost.

Results: Patients receiving laparoscopic Nissen fundoplication were discharged significantly sooner and spent significantly less time convalescing when compared to those who underwent open Nissen fundoplication. Laparoscopic Nissen fundoplication became cost effective at 1.5 to 2 years when compared to omeprazole.

Conclusion: Based on cost analysis, patient satisfaction, acceptable complication rate, and efficient use of time and resources, we recommend laparoscopic Nissen fundoplication as the appropriate treatment in patients who develop recurrent esophagitis after a two-month treatment with omeprazole.

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Figures

Figure 1.
Figure 1.
Mean hospital days after LNF (2.70) and ONF (7.38) P<.05.
Figure 2.
Figure 2.
Mean number of days from surgery until return to work in the LNF (17.9) and ONF (35.3) P<0.05.
Figure 3.
Figure 3.
Cost of civilian and military LNF compared to medical therapy with 40 mg omeprazole and 20 mg omeprazole with 10 mg cisapride three times a day over a 5 year period.
Figure 4.
Figure 4.
Recommended preoperative work-up prior to LNF.
Figure 5.
Figure 5.
Recommended treatment algorithm for surgical treatment of GERD.
See this image and copyright information in PMC

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