Hiatal hernia with severe reflux esophagitis: treatment by superselective vagotomy and Nissen fundoplication.
Thirty-two patients had surgical treatment for severe reflux esophagitis due to sliding hiatal hernia. A superselective vagotomy was done as an adjunct to a Nissen fundoplication as the antireflux procedure. All patients had severe esophagitis; 16 patients (53%) had dysphagia, nine patients (28%) had esophageal stricture, and all had failed an intensive trial of medical treatment with antireflux measures, antacids, and histamine receptor blockers. Follow-up averaged 14.3 months (3 to 38). Three patients (9%) had significant postoperative esophagitis. The other 29 patients, including those with esophageal stricture, are now asymptomatic. We conclude that the combination of a superselective vagotomy and a Nissen fundoplication is a safe and effective operation for the treatment of severe reflux esophagitis.
D000328:Adult; D000368:Aged; D003680:Deglutition Disorders / Q000209:etiology; D004724:Endoscopy; D004940:Esophageal Stenosis / Q000209:etiology; D004942:Esophagitis, Peptic / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D005748:Gastric Fundus / Q000601:surgery*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006548:Hernia, Diaphragmatic / Q000601:surgery*; D006551:Hernia, Hiatal / Q000150:complications / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008722:Methods; D008875:Middle Aged; D011183:Postoperative Complications; D014628:Vagotomy / Q000379:methods*; D014629:Vagotomy, Proximal Gastric / Q000379:methods*