Tailoring Antireflux Surgery: A Randomized Clinical Trial

作者：Lars Rydberg, Magnus Ruth, Hasse Abrahamsson, Lars R. Lundell · 发表于：World Journal of Surgery · 年份：1999 · DOI：10.1007/pl00012356 · 被引用次数：144 · 研究领域：Gastroesophageal reflux and treatments、Esophageal and GI Pathology、Eosinophilic Esophagitis

A hypothesis has been formulated that mandates the adjustment of antireflux surgery to either a total or a partial wrap depending on the motor function of the esophagus to avoid dysphagia and other obstructive complaints. This hypothesis has been tested in a randomized, clinical trial where 106 chronic gastroesophageal reflux patients were allocated to either a total Nissen-Rossetti (n = 53) or a Toupet partial posterior (n = 53) fundoplication, irrespective of their preoperative esophageal motor function. All patients were followed at least 3 years, during which time none had a relapse of moderate to severe reflux symptoms. Motor dysfunctions defined as peristaltic amplitude </= 30 mmHg in the distal third and failed primary peristalsis with or without > 20% simultaneous contractions were noted in 67 patients preoperatively, but these patients did not have a specific symptom profile (e.g., dominated by obstructive symptoms) nor did seven patients with "aperistaltic esophagus." The incidence of dysphagia decreased from 20% preoperatively to 8% (mild) at 3 years after the operation with no difference between the surgical procedures. We were unable to demonstrate a relation between preoperative manometric findings and postoperative symptoms when assessed in the total group or when subdivided by the type of fundoplication (r < 0.3). Flatulence occurred more frequently among those with a total fundic wrap (p < 0.01). When patients representing motor dysfunction (see above) were s...