[Value of a "floppy" Nissen in the treatment of gastroesophageal reflux. Apropos of 117 cases].
The Nissen fundoplication is the most widely used antireflux procedure. However this operation is associated with several specific complications. To prevent these complications, an alternative antireflux procedure ("floppy" Nissen) has been designed. This investigation was conducted to investigate the effects of the floppy Nissen performed on 117 patients, between 1978 and 1990. Indication for surgery was the endoscopic discovery of stage I and II oesophagitis (59 cases), III and IV oesophagitis (25 cases) or an associated disease (gallstones: 25 cases, duodenal ulcer: 8 cases), pH monitoring used preoperatively in 47 cases showed an important reflux in 33 cases (70%). Preoperative manometry exploration (71 cases) showed a low pressure of the low oesophageal sphincter (LOS) in 63 cases (89%). The "floppy" Nissen procedure was performed over a length 4 to 6 cm. The folds of the diaphragm were closed back behind the oesophagus in 40 cases. During the postoperative period the pH-data were restored to normal range in 73% (18/26 cases), and the value of the LOS was restored in 74% (19/26 cases). The mean duration of clinical follow-up study of 99 patients was 3.22 years. Improvement in clinical symptoms was noted for 86%; 13% had specific Nissen complications (9 gall-bloat syndrome, 4 intermittent dysphagia). Six patients had to be reoperated. This technique allowed good control of the reflux symptoms, with a low incidence of mechanical complications.
Rohr
S
S
Service de Chirurgie Générale et Digestive, CHU de Strasbourg-Hautepierre.
Benzaoui
H
H
de Manzini
N
N
Dai
B
B
Meyer
C
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011859:Radiography; D014629:Vagotomy, Proximal Gastric; D015167:Vagotomy, Truncal
Valeur du "floppy" Nissen dans le traitement du reflux gastro-oesophagien. A propos de 117 cas.