The floppy Nissen fundoplication. Effective long-term control of pathologic reflux
P. E. Donahue, S. Samelson, L. M. Nyhus and C. T. Bombeck
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.
