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Ann Thorac Surg 1985;39:508-511
© 1985 The Society of Thoracic Surgeons

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Articles

Total Fundoplication with or without Gastroplasty for Gastroesophageal Reflux: Comparative Study

From the Gastroenterological and Surgical Services, University Hospital, and the Thoracic Surgical Service, Hospital "La Fé," Valencia, Spain

Accepted for publication June 4, 1984.

^* Address reprint requests to Dr. Tomás Ridocci, Servicio de Aparato Digestivo (Cátedra de Patología General), Hospital Universitario, Avda de Blasco Ibañez 17, Valencia 10, Spain

The results of clinical, radiographic, manometric, and pH-metric studies of two groups of patients with reflux esophagitis treated by total (Nissen) fundoplication with or without a Collis esophagus-lengthening gastroplasty were compared. On postoperative follow-up, clinical recurrence of gastrophageal reflux was found in 5 of the 76 patients in the Nissen group, whereas none of the 46 patients in the Collis-Nissen group had reflux. A dramatic reduction in the clinical score was observed for all patients, and postoperative clinical morbidity was similar in both groups. Postoperative radiographic recurrence of hiatal hernia was found in 11 of 60 patients in the Nissen group, but not in any of the patients in the Collis-Nissen group. The lower esophageal sphincter pressure was significantly increased after operation in both groups (p < 0.05). The postoperative "common cavity test" and acid reflux test were positive in 9% of the patients having Nissen fundoplication alone and 11% of those having the Collis-Nissen procedure; in the latter group, both tests were positive in only 1 asymptomatic patient. These results demonstrate that the standard Nissen repair is a good surgical technique for management of uncomplicated reflux esophagitis and that the Collis-Nissen procedure is the most effective method of surgical repair for almost all patients with complicated reflux esophagitis.

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