Effects of fundoplication on the antireflux mechanism

Johnsson, Folke; Joelsson, B.; Gudmundsson, K.; Florén, Claes‐Henrik; Walther, Bruno

doi:10.1002/bjs.1800741212

Cited by 33 publications

(14 citation statements)

References 10 publications

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“…After Nissen fundoplication total, upright, and supine reflux time decrease significantly although normalisation of 24 hour pH metry variables is less frequently found than symptomatic relief or healing of oesophagitis.7 [17][18][19][20] In our study total reflux time normalised postoperatively in 25 of 28 successfully operated patients with total reflux time >4% preoperatively. In three patients, however, abnormal reflux persisted despite clinical and endoscopic improvement.…”

Section: Discussionmentioning

confidence: 56%

“…'3-16 Twenty four hour pH metry is especially helpful in diagnosing gastro-oesophageal reflux disease in patients with reflux symptoms in the absence of endoscopic oesophagitis.16 The technique is also applicable to evaluate the efficacy of medical or surgical treatment. Recent studies have shown that the Nissen fundoplication significantly decreases gastrooesophageal reflux with normalisation of 24 hour pH metry parameters in up to 80% of patients.7 [17][18][19][20] Little is known, however, on the effect of the Belsey Mark IV antireflux procedure on 24 hour pH metry variables. The aims of this study were therefore to evaluate the efficacy of the Belsey Mark IV fundoplication with special emphasis on 24 hour pH metry and the relation between lower oesophageal sphincter pressure and pH metry data.…”

Section: Introductionmentioning

confidence: 99%

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Prospective evaluation of 24 hour ambulatory pH metry in Belsey Mark IV antireflux surgery.

Horbach

Masclee

Lamers

et al. 1994

Gut

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This study evaluated the effect of the 2700 Belsey Mark IV fundoplication on 24 hour ambulatory pH metry variables. Thirty seven patients with confirmed gastrooesophageal reflux disease who had a Belsey Mark IV antireflux procedure were evaluated preoperatively and three to six months postoperatively including endoscopy, lower oesophageal sphincter manometry, and 24 hour ambulatory pH metry. In 30 of 37 patients the Belsey Mark IV fundoplication was judged successful based on symptom relief and healing of oesophagitis. In these 30 patients percentage reflux for total, upright, and supine time (median and range) decreased significantly (p<0.001) from 10-0% (2.7-35.3%)/ 10X8% (3-2-39-9%), and 6-7 (0.0-33-0%) respectively to 0.5% (0.0-7-4%), 0-6% (0.0-13.7%), and 0.1% (0O0-4/9%) after operation. This decrease in reflux time resulted predominantly from a significant (p<0001) reduction in the number of reflux episodes from 98 (23-231) to 14 (0-82) postoperatively. Normalisation of total reflux time (upper limit of normal for time with pH below 4:4%) was found in 89% and normalisation of total and upright and supine reflux in 64% of successfully operated patients with confirmed abnormal acid reflux before operation. A successful antireflux procedure was associated with significant (p<0.001) increases in lower oesophageal sphincter pressure from 7*8 (0.6) mm Hg to 14-5 (0-7) mm Hg mean (SEM). In seven patients with a failed antireflux operation basal lower oesophageal sphincter pressure did not change significantly (preoperative value 5-7 (1-3) mm Hg; postoperative value 7-8 (0.8) mm Hg). In these patients reflux time did not decrease after the operation and remained in the abnormal range in all patients. It is concluded that a successful, in contrast with a failed, Belsey Mark IV fundoplication is associated with significant decreases in total, upright, and supine reflux time. Normalisation of pH metry variables is not a prerequisite for successful antireflux surgery.

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Section: Discussionmentioning

confidence: 56%

Section: Introductionmentioning

confidence: 99%

Prospective evaluation of 24 hour ambulatory pH metry in Belsey Mark IV antireflux surgery.

Horbach

Masclee

Lamers

et al. 1994

Gut

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“…Fundoplication also significantly reduced the number of reflux episodes from a total of 327 (mean 18-2 (4 3)) before surgery to 53 (mean [2][3][4][5][6][7][8][9] (1-6)) after surgery (p<0-001). Reflux episodes occurred in only six of the 18 patients after surgery, and in only three was the distal oesophageal pH below 4 for more than 2% of the postprandial time (upper limit of normal <4%9).…”

Section: Gastro-oesophageal Refluxmentioning

confidence: 97%

Mechanisms underlying the antireflux action of fundoplication.

Ireland

Holloway²,

Toouli³

1993

Gut

164

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The effect offundoplication on patterns of gastrooesophageal reflux and the underlying motor mechanisms were investigated in 18 patients with symptomatic reflux. Oesophageal motility and pH were recorded concurrently after a standard meal. Studies were performed preoperativey and from 5 to 27 months after surgery. Fundoplication virtually eliminated reflux in all but three patients. Control of reflux was associated with a 50% fall in the number of transient lower oesophageal sphincter relaxations, a fall in the proportion oftransient lower oesophageal sphincter relaxations accompanied by reflux from 47% to 17%, and an increase in the mean residual pressure at the gastro-oesophageal junction during swallow induced lower oesophageal sphincter relaxation from 0-7 mm Hg to 6*0 mm Hg. Basal pressure at the gastro-oesophageal junction rose from 10-9 mm Hg to 14*5 mm Hg, however, there was no correlation between postoperative reflux and basal gastro-oesophageal junction pressure. These findings suggest that the antireflux effects of fundoplication result from changes in the mechanical behaviour of the gastro-oesophageal junction that result in inGastroenterology Unit, complete abolition of the high pressure zone Royal Adelaide Hospital during lower oesophageal sphincter relaxation, A C Ireland and reduced triggering of transient lower R H Holloway oesophageal sphincter relaxations.

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“…Surgical treatment aims at constructing a mechanism capable of preventing the reflux of gastric contents into the oesophagus whilst retaining ability to swallow and belch (Johnsson et al . 1987).…”

Section: Introductionmentioning

confidence: 99%

“…However, surgical treatment can have side‐effects. Half of the patients have increased flatulence after fundoplication and a quarter have difficulties in belching (Johnsson et al . 1987, Johansson et al .…”

Section: Introductionmentioning

confidence: 99%

Patients' experiences of illness, operation and outcome with reference to gastro‐oesophageal reflux disease

Nilsson

Larsson

Johnsson

et al. 2002

Journal of Advanced Nursing

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Background. Describing the illness‐story from a patient perspective could increase understanding of living with a chronic disease for health professionals and others, facilitate decision‐making about treatment and enhance information about the outcome from a patient perspective. Aim. To illuminate patients' illness experiences of having a gastro‐oesophageal reflux disease (GORD), going through surgery and the outcome. Methods. Twelve patients were interviewed 5 years after having had the operation; six patients had had fundoplication via laparoscopy and six via open surgery. Each patient was asked to talk openly about their experiences, thoughts, feelings and consequences of living with the illness, going through surgery and the period from surgery to the day of interview. A qualitative content analysis was performed concerning the context of the data and its meaning. Findings. Three central categories were identified and nine subcategories: living with GORD– symptoms of the disease affecting daily living, taking medicines, work, family and social life; concerns related to surgery– decision‐making about the operation, influence by physicians; life after the operation– outcomes and consequences, side‐effects and complications of the operation, sick leave, information and sharing experiences with future patients. All patients were free from symptoms of the illness after surgery independent of type of surgery, but side‐effects from surgical treatment varied individually. Interviewees would have liked information concerning side‐effects after surgery from previous patients. Conclusions. This study contributes to knowledge about patients' long‐term suffering, their control of symptoms and how they have tried to cure themselves, but also about their concerns about surgery and the importance of surgical treatment to their quality of life. They wanted information about treatment, outcome and consequences, not only from a health care perspective but also from previous patients having had the same treatment.

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Effects of fundoplication on the antireflux mechanism

Cited by 33 publications

References 10 publications

Prospective evaluation of 24 hour ambulatory pH metry in Belsey Mark IV antireflux surgery.

Prospective evaluation of 24 hour ambulatory pH metry in Belsey Mark IV antireflux surgery.

Mechanisms underlying the antireflux action of fundoplication.

Patients' experiences of illness, operation and outcome with reference to gastro‐oesophageal reflux disease

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