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[Fundus plication with or without proximal selective vagotomy?].

C Ackermann1, F Harder

  • 1Departement Chirurgie, Kantonsspital Basel.

Schweizerische Medizinische Wochenschrift
|June 20, 1992
PubMed
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Adding proximal gastric vagotomy to fundoplication does not improve reflux disease outcomes. The combined procedure is only beneficial when both reflux and ulcer disease are present.

Area of Science:

  • Gastroenterology
  • Surgical Outcomes
  • Reflux Disease Management

Background:

  • Fundoplication is a common surgical treatment for gastroesophageal reflux disease (GERD).
  • The role of concomitant procedures, such as proximal gastric vagotomy, in improving fundoplication outcomes is debated.
  • Proximal gastric vagotomy is primarily used for peptic ulcer disease treatment.

Purpose of the Study:

  • To evaluate the impact of proximal gastric vagotomy on the long-term results of fundoplication for reflux disease.
  • To compare outcomes between patients undergoing fundoplication alone versus fundoplication with proximal gastric vagotomy.
  • To determine if the addition of proximal gastric vagotomy offers additional benefits for GERD patients.

Main Methods:

  • Retrospective analysis of 141 patients undergoing surgery for reflux disease between 1972 and 1988.

Related Experiment Videos

  • Patients were divided into two groups: fundoplication alone (n=53) and fundoplication with proximal gastric vagotomy (n=88).
  • Outcomes assessed included reflux control, clinical outcome (Visick grades), perioperative morbidity, and adverse side effects (dysphagia, gas-bloat) after a mean 9-year follow-up.

    • Main Results:

    • Both groups showed similar success rates for reflux control (81%) and overall clinical outcomes (Visick I/II: 78% vs. 80%).
    • Perioperative morbidity was comparable between the groups (22% vs. 19%).
    • The incidence of concomitant ulcer disease was significantly higher in the combined procedure group (55% vs. 2%).

    Conclusions:

    • Proximal gastric vagotomy does not enhance the long-term efficacy of fundoplication for managing reflux disease.
    • The combined surgical approach is only indicated when both reflux disease and peptic ulcer disease are concurrently present.
    • Fundoplication alone provides comparable results to the combined procedure for GERD management without ulcer disease.