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Related Experiment Videos

Tailoring antireflux surgery: A randomized clinical trial.

L Rydberg1, M Ruth, H Abrahamsson

  • 1Department of Surgery, Sahlgrenska University Hospital, S-413 45 Gothenburg, Sweden.

World Journal of Surgery
|May 5, 1999
PubMed
Summary

Tailoring antireflux surgery based on esophageal motor function did not reduce dysphagia or improve outcomes in a randomized trial. Both total and partial fundoplication showed similar results for chronic gastroesophageal reflux disease patients.

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Area of Science:

  • Gastroenterology
  • Surgical Innovation
  • Esophageal Motility Disorders

Background:

  • Gastroesophageal reflux disease (GERD) management often involves antireflux surgery.
  • The hypothesis suggests tailoring fundoplication (total vs. partial wrap) based on esophageal motor function to prevent postoperative dysphagia.
  • Preoperative esophageal motor function assessment is crucial for guiding surgical approach.

Purpose of the Study:

  • To test the hypothesis that adjusting antireflux surgery (total vs. partial wrap) based on preoperative esophageal motor function reduces dysphagia and obstructive symptoms.
  • To compare the outcomes of total Nissen-Rossetti fundoplication versus Toupet partial posterior fundoplication in chronic GERD patients.

Main Methods:

  • A randomized clinical trial involving 106 chronic GERD patients.

Related Experiment Videos

  • Patients were allocated to either total Nissen-Rossetti (n=53) or Toupet partial posterior (n=53) fundoplication, irrespective of preoperative esophageal motor function.
  • Follow-up was conducted for at least 3 years, assessing reflux symptom relapse, dysphagia, and flatulence. Esophageal manometry was used to evaluate motor function.

    • Main Results:

    • No moderate to severe reflux symptom relapse occurred in any patient over 3 years.
    • Dysphagia incidence decreased from 20% preoperatively to 8% postoperatively, with no significant difference between surgical groups.
    • No correlation was found between preoperative manometric findings and postoperative symptoms. Flatulence was more frequent after total fundoplication (p < 0.01).

    Conclusions:

    • The study did not support the hypothesis of tailoring antireflux surgery based on preoperative esophageal motor function.
    • Both total and partial fundoplication appear to yield similar outcomes regarding dysphagia and symptom control in chronic GERD.
    • Esophageal motor function did not predict postoperative symptoms or guide surgical choice effectively in this trial.