Ten-year results of a randomized clinical trial of laparoscopic total fundoplication with or without division of the short gastric vessels

Abstract

When total fundoplication is performed it makes no difference whether the fundus is mobilized or not. Both types of repair provide lasting control of reflux.

Surgical Treatment of Gastroesophageal Reflux Disease

“…In a precedent report the same authors have reported subtle manometric differences between the two study groups, offering a physiologic background to a potential difference in functional outcome (Engstrom et al 2004), but it appears that these differences in lower esophageal sphincter response to gastric distension with air do not translate into important and clinically relevant functional correlates. At 10 years follow-up, the authors concluded that with total Fundoplication it makes no difference whether the fundus is mobilized or not and that both types of repair provide long-lasting control of reflux (Mardani et al 2009 (Leggett et al 2000). All patients experienced relief from symptomatic gastroesophageal reflux, whether they received the Rossetti modification or the Nissen Fundoplication.…”

“…Mardani, Lundell and colleagues designed a randomized controlled trial to determine the long-term results of total Nissen Fundoplication with or without division of short gastric vessels in a 10 years follow-up (Mardani et al 2009). They reported that mechanical sideeffects remain a problem following construction of a total wrap, and are perhaps of even greater concern when the operation is performed laparoscopically.…”

“…There is a widely held view among surgeons that a wrap should be short end tension free (deMeester et al 1986;Rossetti et al 1977). However, the optimal length of total wrap to minimize subsequent obstructive complaints remains to be clarified in Mardani and colleagues randomized trial, in fact it may sometimes be necessary to divide some of the short gastric vessels in order to construct a tension free wrap, but this cannot be recommended in routine surgical practice (Mardani et al 2009). In a precedent report the same authors have reported subtle manometric differences between the two study groups, offering a physiologic background to a potential difference in functional outcome (Engstrom et al 2004), but it appears that these differences in lower esophageal sphincter response to gastric distension with air do not translate into important and clinically relevant functional correlates.…”

Quality of Life After Anti-Reflux Surgery in Adults

“…Some measures have been proposed to prevent these surgery-related complications such as mobilization of the gastric fundus by complete division of short gastric vessels to create a floppy wrap. In a randomized study it was found that both dividing and preserving the short gastric vessels provided long term reflux control with no differences in QoL between the two approaches (Mardani et al, 2009). …”

Laparoskopische Fundoplicatio: Lösung des Problems?

“…Der Nutzen oder Nachteil der Fundusmobilisierung wird sehr kontrovers unter Chirurgen diskutiert und wurde in einigen randomisierten Studien untersucht [16,17] …”