Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1993 Apr;217(4):329–337. doi: 10.1097/00000658-199304000-00004

Nissen fundoplication for reflux esophagitis. Long-term clinical and endoscopic results in 109 of 127 consecutive patients.

M Luostarinen 1
PMCID: PMC1242799  PMID: 8466307

Abstract

OBJECTIVE: This study evaluates the clinical and endoscopic long-term results of Nissen fundoplication in reflux esophagitis. SUMMARY BACKGROUND DATA: Nissen fundoplication has been reported to give good results in the treatment of gastroesophageal reflux with success rates up to 78-97%. Most of the previous studies on long-term results of fundoplication have, however, been based on interviews with only sporadic endoscopic examinations. METHODS: Of 127 patients consecutively treated with Nissen fundoplication for reflux esophagitis, 109 were available for follow-up after a median of 77 months. Upper gastrointestinal endoscopy was done in 105 cases, and all the patients with reflux symptoms or abnormal endoscopic observations were referred to esophageal 24-hour pH monitoring and manometry. RESULTS: No symptoms of gastroesophageal reflux were reported by 73 of the 109 patients, but dysphagia was present in 47. Endoscopy showed defective fundic wrap in 24 patients. Objective evidence of reflux was found in 24 patients (endoscopic esophagitis in 18 and pathologic 24-hour pH score without esophagitis in 6). Esophagitis was found in 14 of the 24 patients with defective wrap, but in only 4 of the 81 with infact wrap. CONCLUSIONS: Nissen fundoplication alleviated symptoms of gastroesophageal reflux and cured esophagitis in great majority of cases. The main determinant of outcome was the state of the fundic wrap.

Full text

PDF
337

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Benjamin S. B., Richter J. E., Cordova C. M., Knuff T. E., Castell D. O. Prospective manometric evaluation with pharmacologic provocation of patients with suspected esophageal motility dysfunction. Gastroenterology. 1983 May;84(5 Pt 1):893–901. [PubMed] [Google Scholar]
  2. Bremner C. G. Gastric ulceration after a fundoplication operation for gastroesophageal reflux. Surg Gynecol Obstet. 1979 Jan;148(1):62–64. [PubMed] [Google Scholar]
  3. Breumelhof R., Smout A. J., Schyns M. W., Bronzwaer P. W., Akkermans L. M., Jansen A. Prospective evaluation of the effects of Nissen fundoplication on gastroesophageal reflux. Surg Gynecol Obstet. 1990 Aug;171(2):115–119. [PubMed] [Google Scholar]
  4. Bushkin F. L., Woodward E. R., O'Leary J. P. Occurrence of gastric ulcer after Nissen fundoplication. Am Surg. 1976 Nov;42(11):821–826. [PubMed] [Google Scholar]
  5. Campbell R., Kennedy T., Johnston G. W. Gastric ulceration after Nissen fundoplication. Br J Surg. 1983 Jul;70(7):406–407. doi: 10.1002/bjs.1800700705. [DOI] [PubMed] [Google Scholar]
  6. DeMeester T. R., Bonavina L., Albertucci M. Nissen fundoplication for gastroesophageal reflux disease. Evaluation of primary repair in 100 consecutive patients. Ann Surg. 1986 Jul;204(1):9–20. doi: 10.1097/00000658-198607000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. DeMeester T. R., Johnson L. F. The evaluation of objective measurements of gastroesophageal reflux and their contribution to patient management. Surg Clin North Am. 1976 Feb;56(1):39–53. doi: 10.1016/s0039-6109(16)40834-0. [DOI] [PubMed] [Google Scholar]
  8. Demeester T. R., Johnson L. F., Joseph G. J., Toscano M. S., Hall A. W., Skinner D. B. Patterns of gastroesophageal reflux in health and disease. Ann Surg. 1976 Oct;184(4):459–470. doi: 10.1097/00000658-197610000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Donahue P. E., Samelson S., Nyhus L. M., Bombeck C. T. The floppy Nissen fundoplication. Effective long-term control of pathologic reflux. Arch Surg. 1985 Jun;120(6):663–668. doi: 10.1001/archsurg.1985.01390300013002. [DOI] [PubMed] [Google Scholar]
  10. Feussner H., Petri A., Walker S., Bollschweiler E., Siewert J. R. The modified AFP score: an attempt to make the results of anti-reflux surgery comparable. Br J Surg. 1991 Aug;78(8):942–946. doi: 10.1002/bjs.1800780816. [DOI] [PubMed] [Google Scholar]
  11. Ismail-Beigi F., Horton P. F., Pope C. E., 2nd Histological consequences of gastroesophageal reflux in man. Gastroenterology. 1970 Feb;58(2):163–174. [PubMed] [Google Scholar]
  12. Isolauri J., Reinikainen P., Markkula H. Functional evaluation of interposed colon in esophagus. Manometric and 24-hour pH observations. Acta Chir Scand. 1987 Jan;153(1):21–24. [PubMed] [Google Scholar]
  13. Johnsson F., Joelsson B., Gudmundsson K., Florén C. H., Walther B. Effects of fundoplication on the antireflux mechanism. Br J Surg. 1987 Dec;74(12):1111–1114. doi: 10.1002/bjs.1800741212. [DOI] [PubMed] [Google Scholar]
  14. Johnsson F., Joelsson B., Gudmundsson K., Greiff L. Symptoms and endoscopic findings in the diagnosis of gastroesophageal reflux disease. Scand J Gastroenterol. 1987 Aug;22(6):714–718. doi: 10.3109/00365528709011148. [DOI] [PubMed] [Google Scholar]
  15. Kahrilas P. J., Dodds W. J., Hogan W. J. Effect of peristaltic dysfunction on esophageal volume clearance. Gastroenterology. 1988 Jan;94(1):73–80. doi: 10.1016/0016-5085(88)90612-9. [DOI] [PubMed] [Google Scholar]
  16. Low D. E., Mercer C. D., James E. C., Hill L. D. Post Nissen syndrome. Surg Gynecol Obstet. 1988 Jul;167(1):1–5. [PubMed] [Google Scholar]
  17. MCNALLY E. F., KELLY J. E., Jr, INGELFINGER F. J. MECHANISM OF BELCHING: EFFECTS OF GASTRIC DISTENSION WITH AIR. Gastroenterology. 1964 Mar;46:254–259. [PubMed] [Google Scholar]
  18. NISSEN R. Eine einfache Operation zur Beeinflussung der Refluxoesophagitis. Schweiz Med Wochenschr. 1956 May 18;86(Suppl 20):590–592. [PubMed] [Google Scholar]
  19. Nebel O. T., Fornes M. F., Castell D. O. Symptomatic gastroesophageal reflux: incidence and precipitating factors. Am J Dig Dis. 1976 Nov;21(11):953–956. doi: 10.1007/BF01071906. [DOI] [PubMed] [Google Scholar]
  20. Negre J. B., Markkula H. T., Keyrilainen O., Matikainen M. Nissen fundoplication. Results at 10 year follow-up. Am J Surg. 1983 Nov;146(5):635–638. doi: 10.1016/0002-9610(83)90301-x. [DOI] [PubMed] [Google Scholar]
  21. Negre J. B. Post-fundoplication symptoms. Do they restrict the success of Nissen fundoplication? Ann Surg. 1983 Dec;198(6):698–700. doi: 10.1097/00000658-198312000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. O'Hanrahan T., Marples M., Bancewicz J. Recurrent reflux and wrap disruption after Nissen fundoplication: detection, incidence and timing. Br J Surg. 1990 May;77(5):545–547. doi: 10.1002/bjs.1800770526. [DOI] [PubMed] [Google Scholar]
  23. Richardson J. D., Larson G. M., Polk H. C., Jr Intrathoracic fundoplication for shortened esophagus. Treacherous solution to a challenging problem. Am J Surg. 1982 Jan;143(1):29–35. doi: 10.1016/0002-9610(82)90125-8. [DOI] [PubMed] [Google Scholar]
  24. Rossetti M., Hell K. Fundoplication for the treatment of gastroesophageal reflux in hiatal hernia. World J Surg. 1977 Jul;1(4):439–443. doi: 10.1007/BF01565907. [DOI] [PubMed] [Google Scholar]
  25. Shirazi S. S., Schulze K., Soper R. T. Long-term follow-up for treatment of complicated chronic reflux esophagitis. Arch Surg. 1987 May;122(5):548–552. doi: 10.1001/archsurg.1987.01400170054008. [DOI] [PubMed] [Google Scholar]
  26. Smith D., King N. A., Waldron B., Cullen P. T., Millar B., Fenwick M., Campbell F. C. Study of belching ability in antireflux surgery patients and normal volunteers. Br J Surg. 1991 Jan;78(1):32–35. doi: 10.1002/bjs.1800780111. [DOI] [PubMed] [Google Scholar]
  27. Thor K. B., Silander T. A long-term randomized prospective trial of the Nissen procedure versus a modified Toupet technique. Ann Surg. 1989 Dec;210(6):719–724. doi: 10.1097/00000658-198912000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Woodward E. R., Thomas H. F., McAlhany J. C. Comparison of crural repair and Nissen fundoplication in the treatment of esophageal hiatus hernia with peptic esophagitis. Ann Surg. 1971 May;173(5):782–792. doi: 10.1097/00000658-197105000-00018. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Wyman J. B., Dent J., Heddle R., Dodds W. J., Toouli J., Downton J. Control of belching by the lower oesophageal sphincter. Gut. 1990 Jun;31(6):639–646. doi: 10.1136/gut.31.6.639. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Zaninotto G., DeMeester T. R., Bremner C. G., Smyrk T. C., Cheng S. C. Esophageal function in patients with reflux-induced strictures and its relevance to surgical treatment. Ann Thorac Surg. 1989 Mar;47(3):362–370. doi: 10.1016/0003-4975(89)90374-3. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES