Abstract
Of 46 patients who had Nissen fundoplication for proved gastro-oesophageal reflux, 25 were available for follow up after a median of 20 years, 15 had died of unrelated causes, and six could not be traced. All 25 patients in the follow up study were personally interviewed: 21 consented to an endoscopy, 14 to 24 hour recording of oesophageal pH and manometry, and 15 to radionuclide transit test. Repeat fundoplication for recurrent reflux was performed in two cases during the study. Heartburn and regurgitation were significantly lessened (p < 0.005), but the incidence of dysphagia was slightly increased. Endoscopy showed six of 21 fundic wraps to be defective. Erosive oesophagitis was seen in two patients, and Barrett's oesophagus (histologically confirmed) in one of them and six other patients. Total reflux time was abnormal in four of 14 patients. No patient with an intact fundic wrap seen on endoscopy, only two of seven with Barrett's oesophagus, and one of four with abnormal reflux had oesophagitis. Fundoplication in itself did not affect oesophageal motility or transit, provided that the wrap was intact. It is concluded that Nissen fundoplication gave a reasonably good longterm effect in chronic reflux disease, with the stage of the fundic wrap as the main determinant of outcome.
Full text
PDF





Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- BERMAN J. K., BERMAN E. J. Balanced operations for esophagitis associated with esophageal hiatal hernia. AMA Arch Surg. 1959 Jun;78(6):889–896. [PubMed] [Google Scholar]
- BERNSTEIN L. M., BAKER L. A. A clinical test for esophagitis. Gastroenterology. 1958 May;34(5):760–781. [PubMed] [Google Scholar]
- 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]
- Cooperman A. M. Postoperative alkaline reflux gastritis. Surg Clin North Am. 1976 Dec;56(6):1445–1459. doi: 10.1016/s0039-6109(16)41097-2. [DOI] [PubMed] [Google Scholar]
- DeMeester T. R., Attwood S. E., Smyrk T. C., Therkildsen D. H., Hinder R. A. Surgical therapy in Barrett's esophagus. Ann Surg. 1990 Oct;212(4):528–542. doi: 10.1097/00000658-199010000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 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]
- DeMeester T. R., Johnson L. F. Evaluation of the Nissen antireflux procedure by esophageal manometry and twenty-four hour pH monitoring. Am J Surg. 1975 Jan;129(1):94–100. doi: 10.1016/0002-9610(75)90174-9. [DOI] [PubMed] [Google Scholar]
- 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]
- 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]
- 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]
- Ellis F. H., Jr, Crozier R. E. Reflux control by fundoplication: a clinical and manometric assessment of the Nissen operation. Ann Thorac Surg. 1984 Oct;38(4):387–392. doi: 10.1016/s0003-4975(10)62292-8. [DOI] [PubMed] [Google Scholar]
- 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]
- Gill R. C., Bowes K. L., Murphy P. D., Kingma Y. J. Esophageal motor abnormalities in gastroesophageal reflux and the effects of fundoplication. Gastroenterology. 1986 Aug;91(2):364–369. doi: 10.1016/0016-5085(86)90570-6. [DOI] [PubMed] [Google Scholar]
- 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]
- Isolauri J., Koskinen M. O., Markkula H. Radionuclide transit in patients with colon interposition. J Thorac Cardiovasc Surg. 1987 Oct;94(4):521–525. [PubMed] [Google Scholar]
- 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]
- Johnson L. F., Demeester T. R. Twenty-four-hour pH monitoring of the distal esophagus. A quantitative measure of gastroesophageal reflux. Am J Gastroenterol. 1974 Oct;62(4):325–332. [PubMed] [Google Scholar]
- 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]
- 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]
- 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]
- 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]
- Luostarinen M. Nissen fundoplication for reflux esophagitis. Long-term clinical and endoscopic results in 109 of 127 consecutive patients. Ann Surg. 1993 Apr;217(4):329–337. doi: 10.1097/00000658-199304000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Meyer W., Vollmar F., Bär W. Barrett-esophagus following total gastrectomy. A contribution to it's pathogenesis. Endoscopy. 1979 May;11(2):121–126. doi: 10.1055/s-0028-1098335. [DOI] [PubMed] [Google Scholar]
- NISSEN R. Eine einfache Operation zur Beeinflussung der Refluxoesophagitis. Schweiz Med Wochenschr. 1956 May 18;86(Suppl 20):590–592. [PubMed] [Google Scholar]
- 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]
- 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]
- 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]
- Orringer M. B., Skinner D. B., Belsey R. H. Long-term results of the Mark IV operation for hiatal hernia and analyses of recurrences and their treatment. J Thorac Cardiovasc Surg. 1972 Jan;63(1):25–33. [PubMed] [Google Scholar]
- Ortiz Escandell A., Martinez de Haro L. F., Parrilla Paricio P., Aguayo Albasini J. L., Garcia Marcilla J. A., Morales Cuenca G. Surgery improves defective oesophageal peristalsis in patients with gastro-oesophageal reflux. Br J Surg. 1991 Sep;78(9):1095–1097. doi: 10.1002/bjs.1800780919. [DOI] [PubMed] [Google Scholar]
- Polepalle S. C., McCallum R. W. Barrett's esophagus. Current assessment and future perspectives. Gastroenterol Clin North Am. 1990 Sep;19(3):733–744. [PubMed] [Google Scholar]
- 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]
- 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]
- Siewert J. R., Feussner H., Walker S. J. Fundoplication: how to do it? Peri-esophageal wrapping as a therapeutic principal in gastro-esophageal reflux prevention. World J Surg. 1992 Mar-Apr;16(2):326–334. doi: 10.1007/BF02071541. [DOI] [PubMed] [Google Scholar]
- Skinner D. B. Complications of surgery for gastroesophageal reflux. World J Surg. 1977 Jul;1(4):485–490. doi: 10.1007/BF01565918. [DOI] [PubMed] [Google Scholar]
- Skinner D. B. Surgical management after failed antireflux operations. World J Surg. 1992 Mar-Apr;16(2):359–363. doi: 10.1007/BF02071549. [DOI] [PubMed] [Google Scholar]
- Spechler S. J. Comparison of medical and surgical therapy for complicated gastroesophageal reflux disease in veterans. The Department of Veterans Affairs Gastroesophageal Reflux Disease Study Group. N Engl J Med. 1992 Mar 19;326(12):786–792. doi: 10.1056/NEJM199203193261202. [DOI] [PubMed] [Google Scholar]
- 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]
- 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]
- 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]