Prospective randomized comparison of teres cardiopexy and Nissen fundoplication in the surgical therapy of gastro-oesophageal reflux disease.
Teres cardiopexy was compared with Nissen fundoplication in a prospective randomized study of surgery for gastro-oesophageal reflux disease refractory to medical treatment. Follow-up at 3 months of ten patients undergoing each procedure showed good clinical results and improvement of the mean symptom score in both groups, for cardiopexy from 7.8 to 1.1 (P < 0.01) and for fundoplication from 5.7 to 0.2 (P < 0.01). After 1 year, six of the ten patients undergoing cardiopexy required a second antireflux procedure because of recurrent disease, whereas one reoperation was performed after fundoplication. The mean symptom score after 1 year was higher in patients submitted to cardiopexy than in those receiving fundoplication (3.9 versus 0.3, P < 0.01). The mean endoscopic oesophagitis score after 1 year was no different from preoperative values after cardiopexy (1.9 versus 1.9) but was significantly lower after fundoplication (1.5 versus 0.3, P = 0.01). Ambulatory 24-h pH monitoring showed a significantly higher proportion of total time at pH < 4 after cardiopexy than fundoplication (24.0 versus 3.8 per cent, P < 0.05). Cardiopexy is significantly less effective than fundoplication for the treatment of gastro-oesophageal reflux disease assessed at 1-year follow-up. This study does not support the use of cardiopexy either in conventional or laparoscopic antireflux surgery.
Janssen
I M
IM
Department of Surgery, Municipal Hospital Arnhem, The Netherlands.
Gouma
D J
DJ
Klementschitsch
P
P
van der Heyde
M N
MN
Obertop
H
H
D000328:Adult; D002299:Cardia / Q000601:surgery*; D004945:Esophagoscopy; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005748:Gastric Fundus / Q000601:surgery*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies