Fundoplication avoiding complications of the Nissen procedure: prospective evaluation

The purpose of this study was to evaluate the results of a fundoplication aimed to avoid complications of the Nissen procedure. The procedure combined a posterior hemifundoplication and a short circular fundoplication and their fixation to crura. A total of 67 consecutive patients were prospectively evaluated before and after surgery (median follow-up 24 months). Typical and atypical signs of reflux were present in 96.9% and 28.1% of cases, respectively, before operation versus 12.5% and 6.3% after. Patients alleged dysphagia in 26.6% of cases before surgery and 20.3% after. After operation belching and vomiting were impossible in 6.3% and 29.7% of cases, respectively. The pH test did not demonstrate any pathologic acid esophageal exposure in 93.3% cases after surgery. The mean duration of acid esophageal exposure was 45.1 +/- 21.8% (10-100%) before operation versus 1.9 +/- 4.9% (0-30%) after (p < 0.001). The mean lower esophageal sphincter pressure increased from 12.4 +/- 6.1 cm H2O (0-28 cm H2O) before operation to 20.5 +/- 7.3 cm H2O (11-50 cm H2O) after (p < 0.0001). The velocity of esophageal waves increased from 2.8 +/- 1.1 cm/sec (1.2-5.5) before surgery to 3.1 +/- 1.5 cm/sec (1.4-7.7 cm/sec) after (p < 0.001). None of the Nissen complications were observed, and it was not necessary to reoperate any patient. In conclusion, this procedure is effective, improves esophageal motor activity, and prevents the occurrence of complications of the Nissen procedure. It does not, however, alleviate side effects.