title: Nissen or partial posterior fundoplication: which antireflux procedure has a lower rate of side effects?
abstract: BACKGROUND
  In patients with gastroesophageal reflux disease (GERD) it is still controversial as to which type of antireflux procedure-the Nissen or the partial posterior fundoplication-offers the lower rate of side effects in the long term.
  
  
  METHODS
  In this follow-up study the Nissen fundoplication was performed only in GERD patients with normal oesophageal peristalsis. The partial posterior fundoplication was preserved for patients with weak peristalsis. Only patients with effective postoperative control of GERD were included in the study. The study groups consisted of 77 patients who underwent the Nissen fundoplication and 132 patients who underwent partial posterior fundoplication. Clinical assessment of side effects was performed after a median of 52 months following surgery. Manometric assessment of the lower esophageal sphincter (LES) and of esophageal peristalsis was achieved 6 months after surgery.
  
  
  RESULTS
  Side effects such as dysphagia, bloating, inability to belch and vomit, epigastric pain and early satiety were significantly more common after the Nissen fundoplication than after partial posterior fundoplication. Improvement of the antireflux barrier was equal in both groups; however, LES relaxation was incomplete following the Nissen fundoplication but normal after partial posterior fundoplication. Partial posterior fundoplication resulted in improved oesophageal peristalsis, whereas the Nissen fundoplication caused slight impairment of peristalsis.
  
  
  CONCLUSIONS
  Partial posterior fundoplication is a more physiological antireflux procedure than the Nissen fundoplication, and, therefore, this operation has now become our preferred technique for all GERD patients.
authors.affiliation: Department of General and Transplant Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
authors.forename: Heinz
authors.initials: H
authors.lastname: Wykypiel
authors.forename: Michael
authors.initials: M
authors.lastname: Gadenstaetter
authors.forename: Alexander
authors.initials: A
authors.lastname: Klaus
authors.forename: Paul
authors.initials: P
authors.lastname: Klingler
authors.forename: Gerold J
authors.initials: GJ
authors.lastname: Wetscher
mesh_terms: D003680:Deglutition Disorders / Q000209:etiology; D004947:Esophagus / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000009:adverse effects* / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D010528:Peristalsis; D016896:Treatment Outcome