Long-term follow-up for treatment of complicated chronic reflux esophagitis

In the past 18 years the Nissen fundoplication has undergone a few modifications and changes in our institution and all over the world. The aim of this study is to review the long-term (up to 20 years) results of Nissen fundoplication in 350 patients and to evaluate the effect of major modifications in the technique of fundoplication in these patients. Three hundred fifty patients with symptomatic chronic reflux esophagitis have been treated with Nissen fundoplication in our institution since 1966. They were divided into four groups: patients who had a long, tight fundoplication; patients who had a short, floppy fundoplication; patients with crural approximation; and patients without crural approximation. The preoperative and postoperative findings of these patients were evaluated in each group. Group 1 had more immediate and long-term dysphagia compared with group 2. Also, "gas bloat" syndrome was more prevalent in group 1 than group 2. The location of Nissen fundoplication (chest or abdomen) or the addition of hiatal hernia repair did not change the outcome. In patients with intact Nissen fundoplications, their esophagitis healed, and their symptoms disappeared. The rate of recurrence of symptoms was 5%. Recurrence of symptoms was associated with disruption of the fundoplication, which usually happened within the first two years after operation.