Results of Elective Nissen Fundoplication for Gastro-Oesophageal Reflux in Selected Patients

Abstract

Eighty-one selected patients with documented gastro-oesophageal reflux were managed with standardized transabdominal Nissen fundoplication from 1973 to 1984 and regularly evaluated. None of the patients had undergone previous repair, or had peptic stenosis, acquired oesophageal shortening, or evidence of motility disorder. Operation resulted in prompt disappearance of reflux in all patients, and in a significant increase of low oesophageal sphincter pressure to four times that of the pre-operative level. Two recurrences of reflux were observed respectively 7 and 18 months post-operatively. By actuarial analysis patients were demonstrated to have a 97% probability of remaining free of reflux 5 years after operation. A post-fundoplication gastric ulcer was observed in 3 patients, leading in 1 of them to a total gastrectomy for severe haemorrhage. During the early post-operative period 40% of the patients experienced post-fundoplication symptoms; these persisted in 27% of the 81 patients, but were always mild, and never disturbing. It is concluded that with proper selection, and respect of technical details, the Nissen fundoplication can remain the operation of choice in the management of documented gastro-oesophageal reflux.

Fundoplication: How to do it? Peri‐esophageal wrapping as a therapeutic principal in gastro‐esophageal reflux prevention

“…Splenectomy, often mentioned as a high risk of fundoplication, has decreased, possibly due to improvements in operative technique and because lesions of the spleen are now more often treated conservatively (Table 1). Ellis [32] 1984 92 0 Donahue [5] 1985 77 1.4 O'Rourke [33] 1985 105 0 DeMeester [14] 1987 100 1.0 Shirazi [19] 1987 350 0 Gouillat [34] 1988 81 0 Gossot [11] 1987 96 1 H~iring [35] 1987 214 0 Stuart [26] 1989…”