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Does Fundoplication Help or Hurt?

Thomas T. Hui, MD; Steven M. Fass, MD; Dan I. Giurgiu, MD; Atsushi Iida, MD; Sumito Takagi, MD; Edward H. Phillips, MD

Arch Surg. 2000;135:545-549.

Hypothesis  Nausea associated with gastroesophageal reflux disease is cured by laparoscopic Nissen fundoplication (LNF).

Design  Prospective cohort study of unselected patients who underwent LNF from January 1, 1995, through March 31, 1999. Patients were followed up by a physician for 6 to 36 months.

Setting  A large community teaching hospital.

Patients  One hundred consecutive patients with gastroesophageal reflux disease who underwent LNF; all patients were followed up. Patients were grouped according to the presence (group A, n=33) or absence (group B, n=67) of preoperative nausea. Interventions were LNF, esophageal manometry, 24-hour pH monitoring, and nuclear gastric emptying studies.

Main Outcome Measures  Resolution of symptoms after LNF.

Results  Nausea was the most common atypical symptom of gastroesophageal reflux disease, occurring in 33 patients (33%). There were no differences in esophageal manometry or 24-hour pH results between groups. There was a female preponderance in group A (55% vs 33%; P=.003). Patients in group A had a higher prevalence of preoperative dysphagia (P=.02). Patients with persistent postoperative nausea had a higher prevalence of cough (P=.003) and dysphagia (P=.009). The LNF was more effective in reducing heartburn (95% reduction) and regurgitation (95% reduction) than cough and dysphagia (60% reduction). There was a 79% reduction in the number of patients with nausea (33 to 7; P<.001).

Conclusion  Laparoscopic Nissen fundoplication is effective in eliminating nausea associated with gastroesophageal reflux disease and is not contraindicated in these patients.

From the Department of Surgery, Cedars Sinai Medical Center, Los Angeles (Drs Hui, Fass, Iida, Takagi, and Phillips), and Kaiser Permanente, San Diego (Dr Giurgiu), Calif.

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