The Journal of Thoracic and Cardiovascular Surgery, Vol 76, 665-672, Copyright © 1978 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Gastroplasty and fundoplication in the management of complex reflux problems
FG Pearson, JD Cooer and JM Nelems
Between 1963 and 1976, 220 patients with complex reflux problems were
managed by combining a modified Collis gastroplasty with a Belsey type of
partial fundoplication. All patients had one or more of the following
complicating conditions considered indications for the combined operation:
peptic stricture (104), esophagitis and shortening without stricture (25),
one or more prior hiatal repairs (65), massive herniation (33), and motor
disorders associated with reflux (26). Ninety-six percent of the patients
were evaluated by personal interview from 1 to 15 years after repair. The
operative mortality rate was 0.5 percent. The incidence of significant
symptomatic reflux requiring medical therapy was 3 percent and the
incidence of troublesome dysphagia was 11 percent. No patient has required
further operation for the relief of recurrent symptomatic reflux. Two
patients required additional operation for severe residual dysphagia.
Twenty patients managed by this repair were evaluated by preoperative,
intraoperative, and sequential postoperative esophageal pressure studies.
The mean postoperative pressure of 21.4 mm. Hg was more than double the
preoperative value. Two publications from other centers reported on similar
groups of patients managed by gastroplasty and partial fundoplication,
evaluated by preoperative and postoperative esophageal pressures. In these
latter publications, the percentage increase in postoperative lower
esophageal pressure was significantly less than in our study, and a much
higher incidence of symptomatic reflux was recorded. We suggest that the
differences in postoperative pressures observed in account for the
pronounced differences in the quality of results obtained.
