Randomized trial to study the effect of fundic mobilization on long-term results of Nissen fundoplication

It has been suggested that fundic mobilization in Nissen fundoplication decreases adverse postoperative symptoms and increases the durability of the fundic wrap. There are no previous randomized, prospection long-term studies assessing this. This study addresses the question.

Fifty consecutive patients were randomized to undergo open Nissen-Rossetti fundoplication with total fundic mobilization (n == 26) or an identical procedure without mobilization (n == 24). After a median of 36 (range 6-53) months 49 had endoscopy and a personal interview.

Oesophagitis was cured in 20 of 21 patients who had fundic mobilization and 18 of 19 who did not. a defective fundic wrap was observed in five and recurrent reflux symptoms in six of those who had fundic mobilization compared with two and one respectively of those who did not (P not significant). Recurrent sliding hiatal hernia was observed in nine of those with a mobilized fundus and one of those without (P == 0.02). There was no significant difference in incidence of new-onset long-term dysphagia, subjective belching ability, amount of flatus or bloating between the study groups.

Fundic mobilization did not give any apparent advantage regarding postoperative adverse effects. Instead, it was associated with a higher rate of recurrent hiatal hernia.