Grinnell Regional Medical Center

It takes incredible teamwork to guide a rural hospital in today's challenging environment. Leaders need to be well-informed, innovative, inspiring and compassionate.

We prospectively evaluated the cases of 52 patients who underwent laparoscopic Nissen fundoplication from October 1992 to January 1994 for patient outcome, satisfaction, hospital stay, hospital cost, and disability. All cases were evaluated with historical findings, routine chemistry studies, upper gastrointestinal series, fluoroesophagography for esophageal motor function, gallbladder ultrasonography, and esophagogastroduodenoscopy. Six patients required esophageal manometry for diagnosis. All patients had refractory esophageal reflux disease or complications of chronic esophageal reflux. Forty-nine (94%) of the 52 cases were completed laparoscopically. Ninety percent of those were cured of their symptoms and returned to a normal life-style. The percent had significant improvement, with rare episodes of reflux or dysphagia, and received antacids only occasionally. Hospital stay was reduced to 2.3 days, compared to 8.3 days for the open technique. Hospital cost was reduced to $6,870, compared to $11,990 for the open technique. Mean time until return to work was 15 days in the laparoscopic group, compared to 42 days in the open Nissen group. There were two major complications (4%) and 12 minor complications (24%). There were no deaths. Fifty-one of 52 patients stated that they would recommend the procedure for others with the same problem. Laparoscopic Nissen fundoplication is a safe and effective treatment for refractory esophageal reflux and its complications and has the extra benefit of reduced hospital cost and stay and a more rapid return to work. Preoperative esophageal manometry and 24-h esophageal pH testing may be used selectively with excellent results.