Fundoplication for major reflux in patients with gallstones

Patients referred with gallstones were screened for symptoms of reflux. Positive clinical history led to investigation with an upper gastrointestinal series as well as esophageal pH and manometric studies to identify and quantify reflux. Selected patients with symptomatic reflux in whom major or surgical reflux was discovered underwent the combined procedures of cholecystectomy and fundoplication. In all, 250 patients with gallstones were screened. Sixty patients with symptoms of reflux were considered for further study; of that group, 48 patients had major reflux, 38 of whom underwent the combined operative procedures. Fundoplication alone or in combination with cholecystectomy was carried out on 126 occasions upon 121 patients without a death. The combination of fundoplication and cholecystectomy did not prolong the hospital stay significantly, did not materially increase the incidence of postoperative complications and did not compromise the control of reflux symptoms. The postfundoplication syndrome did not occur following the combined procedures and was observed in only one patient in the entire series. Results of our study justify the liberization of indications for fundoplication in selected patients with gallstones who fulfill the criteria of major reflux, as already outlined.