Effect of fundal mobilisation in Nissen-Rossetti fundoplication on oesophageal transit and dysphagia. A prospective, randomised trial.
OBJECTIVE
To assess the effect on postoperative dysphagia and oesophageal transit of fundal mobilisation during Nissen-Rossetti fundoplication.


METHODS
Prospective, randomised study.


METHODS
University Hospital, Finland.


METHODS
20 consecutive patients with confirmed gastro-oesophageal reflux who were referred for antireflux surgery.


METHODS
Fundoplication with either conventional Nissen-Rossetti procedure or an otherwise identical technique incorporating total fundal mobilisation (n = 10 in each group).


METHODS
Recurrent or persistent symptoms of dysphagia, and the oesophageal transit time of a liquid bolus labelled with radioactive nuclide.


RESULTS
In both groups excellent relief of heartburn and regurgitation was achieved (only 2 patients in each group reported occasional symptoms), one patient had oesophagitis, and the pH returned to the normal range. The incidence of dysphagia was similar in both groups by 6 months postoperatively, but there was significant, though transient, impairment of oesophageal transit after findal mobilisation (p = 0.03).


CONCLUSIONS
Fundal mobilisation did not seem to confer any advantage as fas as the incidence of postoperative dysphagia was concerned. On the contrary, it was associated with transient disturbance in the oesophageal transit time of a liquid bolus. Longer follow up is needed to show if this impairment is of any clinical relevance.
Luostarinen
M E
ME
Department of Clinical Medicine, University of Tampere, Finland.
Koskinen
M O
MO
Isolauri
J O
JO
D003680:Deglutition Disorders / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D004947:Esophagus / Q000503:physiopathology*; D018662:Fundoplication / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome