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Effective Long-term Control of Pathologic Reflux

Philip E. Donahue, MD; Scott Samelson, MD; Lloyd M. Nyhus, MD; C. Thomas Bombeck, MD

Arch Surg. 1985;120(6):663-668.

Abstract
• In 1976 we defined a technique of "floppy" Nissen fundoplication (FNF) that prevented experimental pathologic reflux without preventing gaseous eructations or vomiting (normal reflux) when appropriate. This report describes the one- to eight-year follow-up of the 77 patients operated on since that time. The FNF has been completely effective in preventing pathologic reflux in 75 of 77 patients and has been partially effective in two others who are now subjectively asymptomatic. Adverse side effects were reported by two patients, one with gas-bloat and one with inability to belch or vomit. The lower esophageal sphincter pressure of patients postoperatively was increased to low normal values from a mean of 8.94±1.66 to 14.31±0.7 mm Hg (normal, 21.2±4.2 mm Hg). Since FNF does not cause greatly increased lower esophageal sphincter pressure, the inference that the FNF prevents reflux by altering the physiology of a reflux event is supported. In conclusion, the floppy fundoplication has been an effective operation with a low incidence of adverse side effects and without a tendency for late failure.

(Arch Surg 1985;120:663-668)

Author Affiliations
From the Department of Surgery, University of Illinois College of Medicine, at Chicago, and the Veterans Administration West Side Medical Center, Chicago.

Footnotes
Accepted for publication Feb 12, 1985.

Read before the 92nd annual meeting of the Western Surgical Association, Colorado Springs, Colo, Nov 12, 1984.

Reprint requests to Department of General Surgery (112), Veterans Administration West Side Medical Center, 820 S Damen Ave, Chicago, IL 60612 (Dr Donahue).

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