Long-term efficacy of laparascopic Nissen fundoplication

Background: Laparascopic Nissen fundoplication was introduced to treat therapy-resistant gastro-esophageal reflux disease (GERD), but the long-term efficacy of the procedure is not exactly known.

The aim of this study was to investigate the results of total fundic wrap five years after the operation.

Methods: Upper GI endoscopy, esophageal manometry (Synetics-Medtronic, Sweden), 24 hr pH-metry, gastrointestinal quality of life index questionnaire (GIQLI) was performed by all patients preoperatively and five years after fundoplication.

Results: 7/10 patients had erosive reflux disease (ERD), 3/10 patients had non-ERD (NERD) before the operation. 4/10 had ERD after total fundoplication. No transformation of Barrett was found into dysplasia. Stenosis was not found by endoscopy.

9/10 patients had significant acid reflux before the operation. 4/10 cases showed significant GERD after 5 years. Prolonged reflux episodes were found after surgery with the decreased clearance of the esophageal body. Probably this is why ERD developed in each patient.

GIQLI was showed mild improvement. The most frequent symptoms were abdominal distension and bloating after the operation. Majority of the symptoms were associated with psychical condition, not with GERD.

Conclusions: In 30–40% of all operated cases GERD relapses. The surgical reconstruction of the barrier at gastroesophageal junction by total fundic wrap causes high resistance thus when reflux occur clearance function is blocked. Patient control is suggested after the operation, relapsing patients respond well to PPI therapy.

This study was supported by the grant ETT 550/2003, OTKA F 034 433.