Total fundoplication gastroplasty (Nissen gastroplasty): five-year review

Gastroplasty was introduced by Collis in 1961 and has undergone several modifications. The combination of total fundoplication with gastroplasty was reported in 1977 and referred to as total fundoplication gastroplasty; however, the term Nissen gastroplasty also is commonly used. This article is an extension of the original 1977 report and, to our knowledge, represents the first 5-year review of total fundoplication gastroplasty. Three hundred fifty-one consecutive patients with intractable reflux were preoperatively evaluated by history, radiographic studies, manometric studies with determination of pH, and esophagogastroduodenoscopy prior to surgical management by total fundoplication gastroplasty. There were no operative deaths. Follow-up averaged 6.5 years with an effective clinical review available for 95.4% of the patients, radiographic studies for 92.3%, and manometric studies with pH evaluation for 70.7%. Among the 335 patients with 5 or more years of follow-up, 93.1% had excellent results with normal eating and no investigative evidence of recurrence of reflux, 4.0% had mild residual symptoms, and 2.9% had persistent or recurrent symptoms. With this technique, the problems of overcompetence and dysphagia are substantially reduced because the completion fundoplication is tailored to a length of 1 cm while anatomical stability is maintained with a long intraabdominal segment.