Nissen fundoplication for reflux peptic esophagitis

Area of Science:

• Gastroenterology
• Surgical Procedures
• Esophageal Disorders

Background:

• Gastroesophageal reflux disease (GERD) and peptic esophagitis are common conditions.
• Nissen fundoplication is a surgical treatment for severe GERD.
• Long-term outcomes and side effects of Nissen fundoplication require ongoing evaluation.

Purpose of the Study:

• To evaluate the long-term efficacy and safety of Nissen fundoplication for reflux peptic esophagitis.
• To assess the incidence of recurrent esophagitis and the prevalence of the gas-bloat syndrome post-surgery.
• To investigate the impact of Nissen fundoplication on lower esophageal sphincter manometry.

Main Methods:

• Retrospective analysis of 165 patients treated with Nissen fundoplication.
• Comparison of current outcomes with historical data from 104 patients.
• Assessment of esophagitis recurrence, gas-bloat syndrome symptoms, and lower esophageal sphincter pressure via manometry.

Main Results:

• Persistent or recurrent esophagitis occurred in approximately 10% of patients, similar to previous reports (8%).
• The gas-bloat syndrome, initially present in about 50% of patients, showed marked reduction at four-year follow-up, with 87% experiencing absence or insignificance.
• Manometric studies revealed a nearly three-fold increase in resting lower esophageal sphincter pressure (p < .001) post-fundoplication.

Conclusions:

• Nissen fundoplication demonstrates sustained effectiveness in managing reflux peptic esophagitis with uncommon late recurrence.
• The gas-bloat syndrome, though frequent early on, significantly improves over time.
• Manometric assessment of lower esophageal sphincter pressure may offer a reliable prognostic indicator for surgical success.