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Ann Thorac Surg 1991;51:34-38
© 1991 The Society of Thoracic Surgeons

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Articles

Intrathoracic nissen fundoplication: Long-term clinical and ph-monitoring evaluation

Digestive Surgery Unit and Gastroenterology Unit, Louvain Medical School and St-Luc Hospital, Brussels, Belgium

Accepted for publication August 22, 1990.

^_* Address reprint requests to Dr Collard, Digestive Surgery Unit, St-Luc Hospital, 10 Hippocrate Ave, Brussels, Belgium.

From 1976 until April 1989, 31 intrathoracic total fundoplications were performed for reflux espphagitis and irreducible hiatus hernia. In the first 16 patients (group 1) the operation was complicated with acute perforation of the wrap in 4 cases, bronchogastric fistula in 1, and herniation of the wrap higher in the chest in 1. Technical modifications were applied to 15 more recent patients (group 2). These are enlargement of the hiatus, looseness of the wrap and its appropriate anchorage, avoidance of forceps when handling the stomach, care with the vagi, and efficient gastric decompression in the postoperative period. The postoperative course was always uneventful in group 2. Twenty-six patients, who still have their initial wrap, were considered for clinical evaluation: 11 from group 1 (mean follow-up, 81.5 months) and 15 from group 2 (mean follow-up, 32.8 months). All are free from any symptom of reflux; gas-bloat syndrome is infrequent and dysphagia is relieved. Twenty-four-hour pH monitoring, performed in 14 patients (3 from group 1 and 11 from group 2) (mean follow-up, 42 months), was normal in 13; a pathological upright reflux (time pH <4, 8.4%) was demonstrated in one symptom-free woman in whom endoscopy was unremarkable. Mechanisms of complications experienced in group 1 are analyzed in the light of the technical evolution of the procedure, and the place of the intrathoracic total fundoplication in the management of short esophagus is defined, considering the other available surgical techniques.

This article has been cited by other articles:

				F. Volonte, J.-M. Collard, L. Goncette, C. Gutschow, and P. Strignano Intrathoracic Periesophageal Fundoplication for Short Esophagus: A 20-Year Experience Ann. Thorac. Surg., January 1, 2007; 83(1): 265 - 271. [Abstract] [Full Text] [PDF]

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