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Outcome 5 years after 360 degree fundoplication for gastro-oesophageal reflux disease

Johansson, Jan LU ; Johnsson, Folke LU ; Joelsson, B; Florén, C H LU and Walther, B LU (1993) In The British journal of surgery 80(1). p.9-46
Abstract

Forty patients with a mean age of 45 (range 22-65) years were operated on between 1982 and 1985 for gastro-oesophageal reflux disease with a short floppy 360 degree fundoplication. The results of the operation were determined by endoscopy, oesophageal manometry, ambulatory 24-h pH recording and symptom evaluation 6 months and 5 years after operation. These results were compared with findings in healthy controls. The median pressure in the lower oesophageal high-pressure zone was 13.3 (interquartile range (i.q.r.) 11.3-21.3) mmHg after 5 years, which did not differ significantly from the value at 6 months' follow-up or from that in controls. It was, however, significantly higher than the preoperative pressure. The median intra-abdominal... (More)

Forty patients with a mean age of 45 (range 22-65) years were operated on between 1982 and 1985 for gastro-oesophageal reflux disease with a short floppy 360 degree fundoplication. The results of the operation were determined by endoscopy, oesophageal manometry, ambulatory 24-h pH recording and symptom evaluation 6 months and 5 years after operation. These results were compared with findings in healthy controls. The median pressure in the lower oesophageal high-pressure zone was 13.3 (interquartile range (i.q.r.) 11.3-21.3) mmHg after 5 years, which did not differ significantly from the value at 6 months' follow-up or from that in controls. It was, however, significantly higher than the preoperative pressure. The median intra-abdominal length of the high-pressure zone was 1.7 (i.q.r. 1.3-2.3) cm after 5 years, significantly less than at 6 months but equal to control length. Measurement of the proportion of total time at pH < 4 at 5 years (median 0.2 (i.q.r. 0.0-0.6) per cent) and 6 months after operation revealed a significant reduction in acid reflux compared with preoperative values and normal controls. There was no significant difference in acid exposure between the two postoperative investigations. Endoscopy showed that 27 patients had no oesophagitis, three had erythema and three persistent Barrett's oesophagus 5 years after operation. Normal belching was possible in 22 patients and 18 experienced increased flatulence 5 years after fundoplication. An independent gastroenterologist found that the result was excellent in 16 patients, good in 16 and fair in four; two patients had a poor overall outcome of the operation. It is concluded that a 360 degree fundoplication provides good long-term control of reflux and that slight symptoms of overcompetence are common among patients operated on without affecting the overall result.

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organization
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type
Contribution to journal
publication status
published
subject
keywords
Adult, Aged, Esophagoscopy, Esophagus/pathology, Female, Follow-Up Studies, Gastric Fundus/surgery, Gastroesophageal Reflux/pathology, Humans, Hydrogen-Ion Concentration, Male, Manometry, Middle Aged, Pressure, Treatment Outcome
in
The British journal of surgery
volume
80
issue
1
pages
4 pages
publisher
John Wiley & Sons
external identifiers
  • scopus:0027419458
ISSN
0007-1323
DOI
10.1002/bjs.1800800118
language
English
LU publication?
yes
id
d9b4a5ad-8acc-460e-8c85-84e1817b561d
date added to LUP
2019-05-26 18:40:41
date last changed
2019-08-21 09:10:04
@article{d9b4a5ad-8acc-460e-8c85-84e1817b561d,
  abstract     = {<p>Forty patients with a mean age of 45 (range 22-65) years were operated on between 1982 and 1985 for gastro-oesophageal reflux disease with a short floppy 360 degree fundoplication. The results of the operation were determined by endoscopy, oesophageal manometry, ambulatory 24-h pH recording and symptom evaluation 6 months and 5 years after operation. These results were compared with findings in healthy controls. The median pressure in the lower oesophageal high-pressure zone was 13.3 (interquartile range (i.q.r.) 11.3-21.3) mmHg after 5 years, which did not differ significantly from the value at 6 months' follow-up or from that in controls. It was, however, significantly higher than the preoperative pressure. The median intra-abdominal length of the high-pressure zone was 1.7 (i.q.r. 1.3-2.3) cm after 5 years, significantly less than at 6 months but equal to control length. Measurement of the proportion of total time at pH &lt; 4 at 5 years (median 0.2 (i.q.r. 0.0-0.6) per cent) and 6 months after operation revealed a significant reduction in acid reflux compared with preoperative values and normal controls. There was no significant difference in acid exposure between the two postoperative investigations. Endoscopy showed that 27 patients had no oesophagitis, three had erythema and three persistent Barrett's oesophagus 5 years after operation. Normal belching was possible in 22 patients and 18 experienced increased flatulence 5 years after fundoplication. An independent gastroenterologist found that the result was excellent in 16 patients, good in 16 and fair in four; two patients had a poor overall outcome of the operation. It is concluded that a 360 degree fundoplication provides good long-term control of reflux and that slight symptoms of overcompetence are common among patients operated on without affecting the overall result.</p>},
  author       = {Johansson, Jan and Johnsson, Folke and Joelsson, B and Florén, C H and Walther, B},
  issn         = {0007-1323},
  keyword      = {Adult,Aged,Esophagoscopy,Esophagus/pathology,Female,Follow-Up Studies,Gastric Fundus/surgery,Gastroesophageal Reflux/pathology,Humans,Hydrogen-Ion Concentration,Male,Manometry,Middle Aged,Pressure,Treatment Outcome},
  language     = {eng},
  number       = {1},
  pages        = {9--46},
  publisher    = {John Wiley & Sons},
  series       = {The British journal of surgery},
  title        = {Outcome 5 years after 360 degree fundoplication for gastro-oesophageal reflux disease},
  url          = {http://dx.doi.org/10.1002/bjs.1800800118},
  volume       = {80},
  year         = {1993},
}