Lower esophageal sphincter characteristics and esophageal acid exposure following partial or 360 degrees fundoplication: results of a prospective, randomized, clinical study.
In a prospective, randomized, clinical trial, we compared a partial (180-200 degrees, Toupet) with a total fundoplication (360 degrees, Rossetti) in the surgical treatment of gastroesophageal reflux disease. Seventy-one patients entered the trial; 33 were allocated to a partial fundoplication and 38 to a 360 degrees fundic wrap. Each patient was investigated prior to as well as 3 and/or 6 months after the operation, including an endoscopic and clinical assessment. Manometry was carried out via a triple lumen catheter and the pressure in the high pressure zone (HPZ) in the distal esophagus was measured as well as the length of the intraabdominal segment by a "station pull-through" technique. Acid exposure of the esophageal mucosa was evaluated by ambulatory 24-hour pH measurements. Acid exposure of the esophageal mucosa was "normalized" by the 2 operations. In addition, the length of the HPZ was increased to a "normal" level by both operations. The pressure of the HPZ was, however, "normalized" only in patients allocated to a Rossetti fundoplication, whereas patients operated on with a partial fundoplication had a significantly lower HPZ pressure (p less than 0.01). The clinical assessment revealed excellent results in both groups with no significant differences between the 2 operations except for a higher incidence of dysphagia at 3 months after a Rossetti fundoplication (p less than 0.01), which disappeared during the subsequent 3 months.
Lundell
L
L
Department of Surgery, Sahlgren's Hospital, University of Göteborg, Sweden.
Abrahamsson
H
H
Ruth
M
M
Sandberg
N
N
Olbe
L C
LC
D000328:Adult; D000368:Aged; D004943:Esophagogastric Junction / Q000503:physiopathology*; D004947:Esophagus / Q000378:metabolism*; D005260:Female; D005748:Gastric Fundus / Q000601:surgery*; D005764:Gastroesophageal Reflux / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008722:Methods; D008875:Middle Aged; D011446:Prospective Studies