Nissen fundoplication for gastroesophageal reflux disease

T. R. DeMeester, L. Bonavina, M. Albertucci

Research output: Contribution to journalArticle

726 Citations (Scopus)

Abstract

One hundred consecutive patients had a primary Nissen fundoplication for gastroesohageal reflux disease. None of the patients had previous gastaric or esophageal surgery or evidence of esophageal stricture or motility disorder. The primary symptom was persistent heartburn in 89 patients and aspiration in 11. An abnormal pattern of esophageal acid exposure was documented in all patients with 24-hour esophageal pH monitoring. By actuarial analysis, the operation was 91% effective in the control of reflux symptoms over a 10-year period. The incidence of postoperative symptomatic gas bloat and increased flatus was lower in patients with preoperative abnormal manometric measurements of the distal esophageal sphincter (p <0.05). Three modifications in operative technique were made during the course of the study to minimize the side effects of the operation. First, enlarging the caliber of the bougie to size the fundoplication reduced the incidence of temporary swallowing discomfort from 83 to 39% (p <0.01). Second, shortening the length for the fundoplication decreased the incidence of persistent dysphagia from 21 to 3% (p <0.01). Third, mobilizing the gastric fundus for construction of the fundoplication increased the incidence of complete distal esophageal sphincter relaxation on swallowing from 31 to 71% (p <0.05). This was done to prevent the delayed esophageal acid clearance secondary to incomplete sphincter relaxation observed after operation in five of 36 studied patients. It is concluded that by proper patient selection and the incorporation of the above surgical techniques, the Nissen fundoplication can re-establish a competent cardia and provide relief of reflux symptoms with minimal side effects.

Original languageEnglish
Pages (from-to)9-20
Number of pages12
JournalAnnals of Surgery
Volume204
Issue number1
Publication statusPublished - 1986

Fingerprint

Fundoplication
Gastroesophageal Reflux
Incidence
Deglutition
Actuarial Analysis
Gastric Fundus
Esophageal pH Monitoring
Flatulence
Esophageal Stenosis
Heartburn
Cardia
Acids
Deglutition Disorders
Patient Selection
Gases

ASJC Scopus subject areas

  • Surgery

Cite this

DeMeester, T. R., Bonavina, L., & Albertucci, M. (1986). Nissen fundoplication for gastroesophageal reflux disease. Annals of Surgery, 204(1), 9-20.

Nissen fundoplication for gastroesophageal reflux disease. / DeMeester, T. R.; Bonavina, L.; Albertucci, M.

In: Annals of Surgery, Vol. 204, No. 1, 1986, p. 9-20.

Research output: Contribution to journalArticle

DeMeester, TR, Bonavina, L & Albertucci, M 1986, 'Nissen fundoplication for gastroesophageal reflux disease', Annals of Surgery, vol. 204, no. 1, pp. 9-20.
DeMeester, T. R. ; Bonavina, L. ; Albertucci, M. / Nissen fundoplication for gastroesophageal reflux disease. In: Annals of Surgery. 1986 ; Vol. 204, No. 1. pp. 9-20.
@article{64e4dbefdf084fcbb4c6d1d99652366f,
title = "Nissen fundoplication for gastroesophageal reflux disease",
abstract = "One hundred consecutive patients had a primary Nissen fundoplication for gastroesohageal reflux disease. None of the patients had previous gastaric or esophageal surgery or evidence of esophageal stricture or motility disorder. The primary symptom was persistent heartburn in 89 patients and aspiration in 11. An abnormal pattern of esophageal acid exposure was documented in all patients with 24-hour esophageal pH monitoring. By actuarial analysis, the operation was 91{\%} effective in the control of reflux symptoms over a 10-year period. The incidence of postoperative symptomatic gas bloat and increased flatus was lower in patients with preoperative abnormal manometric measurements of the distal esophageal sphincter (p <0.05). Three modifications in operative technique were made during the course of the study to minimize the side effects of the operation. First, enlarging the caliber of the bougie to size the fundoplication reduced the incidence of temporary swallowing discomfort from 83 to 39{\%} (p <0.01). Second, shortening the length for the fundoplication decreased the incidence of persistent dysphagia from 21 to 3{\%} (p <0.01). Third, mobilizing the gastric fundus for construction of the fundoplication increased the incidence of complete distal esophageal sphincter relaxation on swallowing from 31 to 71{\%} (p <0.05). This was done to prevent the delayed esophageal acid clearance secondary to incomplete sphincter relaxation observed after operation in five of 36 studied patients. It is concluded that by proper patient selection and the incorporation of the above surgical techniques, the Nissen fundoplication can re-establish a competent cardia and provide relief of reflux symptoms with minimal side effects.",
author = "DeMeester, {T. R.} and L. Bonavina and M. Albertucci",
year = "1986",
language = "English",
volume = "204",
pages = "9--20",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Nissen fundoplication for gastroesophageal reflux disease

AU - DeMeester, T. R.

AU - Bonavina, L.

AU - Albertucci, M.

PY - 1986

Y1 - 1986

N2 - One hundred consecutive patients had a primary Nissen fundoplication for gastroesohageal reflux disease. None of the patients had previous gastaric or esophageal surgery or evidence of esophageal stricture or motility disorder. The primary symptom was persistent heartburn in 89 patients and aspiration in 11. An abnormal pattern of esophageal acid exposure was documented in all patients with 24-hour esophageal pH monitoring. By actuarial analysis, the operation was 91% effective in the control of reflux symptoms over a 10-year period. The incidence of postoperative symptomatic gas bloat and increased flatus was lower in patients with preoperative abnormal manometric measurements of the distal esophageal sphincter (p <0.05). Three modifications in operative technique were made during the course of the study to minimize the side effects of the operation. First, enlarging the caliber of the bougie to size the fundoplication reduced the incidence of temporary swallowing discomfort from 83 to 39% (p <0.01). Second, shortening the length for the fundoplication decreased the incidence of persistent dysphagia from 21 to 3% (p <0.01). Third, mobilizing the gastric fundus for construction of the fundoplication increased the incidence of complete distal esophageal sphincter relaxation on swallowing from 31 to 71% (p <0.05). This was done to prevent the delayed esophageal acid clearance secondary to incomplete sphincter relaxation observed after operation in five of 36 studied patients. It is concluded that by proper patient selection and the incorporation of the above surgical techniques, the Nissen fundoplication can re-establish a competent cardia and provide relief of reflux symptoms with minimal side effects.

AB - One hundred consecutive patients had a primary Nissen fundoplication for gastroesohageal reflux disease. None of the patients had previous gastaric or esophageal surgery or evidence of esophageal stricture or motility disorder. The primary symptom was persistent heartburn in 89 patients and aspiration in 11. An abnormal pattern of esophageal acid exposure was documented in all patients with 24-hour esophageal pH monitoring. By actuarial analysis, the operation was 91% effective in the control of reflux symptoms over a 10-year period. The incidence of postoperative symptomatic gas bloat and increased flatus was lower in patients with preoperative abnormal manometric measurements of the distal esophageal sphincter (p <0.05). Three modifications in operative technique were made during the course of the study to minimize the side effects of the operation. First, enlarging the caliber of the bougie to size the fundoplication reduced the incidence of temporary swallowing discomfort from 83 to 39% (p <0.01). Second, shortening the length for the fundoplication decreased the incidence of persistent dysphagia from 21 to 3% (p <0.01). Third, mobilizing the gastric fundus for construction of the fundoplication increased the incidence of complete distal esophageal sphincter relaxation on swallowing from 31 to 71% (p <0.05). This was done to prevent the delayed esophageal acid clearance secondary to incomplete sphincter relaxation observed after operation in five of 36 studied patients. It is concluded that by proper patient selection and the incorporation of the above surgical techniques, the Nissen fundoplication can re-establish a competent cardia and provide relief of reflux symptoms with minimal side effects.

UR - http://www.scopus.com/inward/record.url?scp=0022528761&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0022528761&partnerID=8YFLogxK

M3 - Article

VL - 204

SP - 9

EP - 20

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 1

ER -