Impact of laparoscopic nissen fundoplication with prosthetic hiatal closure on esophageal body motility: Results of a prospective randomized trial.
OBJECTIVE
Prosthetic crural closure does not adversely influence esophageal body motility. In most patients, postoperative increased dysphagia resolves spontaneously during the first months after surgery.


METHODS
Prospective randomized trial. We compared patients who underwent laparoscopic Nissen fundoplication with simple sutured hiatal closure and those who underwent laparoscopic Nissen fundoplication with prosthetic hiatal closure.


METHODS
University-affiliated community hospital.


METHODS
Forty consecutive patients who underwent laparoscopic Nissen fundoplication for gastroesophageal reflux disease.


METHODS
A 360 degrees Nissen fundoplication with simple sutured crura (n = 20; nonmesh group) vs the same procedure with posterior 1 x 3-cm polypropylene onlay mesh prosthesis (n = 20; mesh group).


METHODS
Recurrences; postoperative dysphagia rate; localization, length, and pressure of the lower esophageal sphincter (LES); results of 24-hour pH monitoring; esophageal body motility; peristalsis; and esophageal amplitude of contraction and interrupted waves.


RESULTS
Preoperatively, both groups had pathological LES pressure and DeMeester scores. These values improved significantly (P < .01) after surgery and remained stable at 1 year after surgery. Patients in the nonmesh group had a significantly lower LES pressure 1 year after surgery compared with those in the mesh group. There were no significant differences in postoperative mean LES length (4.1 vs 3.8 cm), LES relaxation (93.4% vs 92.4%), and intra-abdominal LES length (2.1 vs 2.1 cm). Patients in the mesh group had fewer simultaneous waves and interrupted waves 1 year after surgery, but the difference between groups was not significant. There were no significant differences in interrupted waves and amplitude of contraction between groups 1 year after surgery.


CONCLUSIONS
Laparoscopic Nissen fundoplication with prosthetic crural closure does not impair postoperative esophageal body motility compared with laparoscopic Nissen fundoplication with simple suture hiatal closure, although it is associated with a higher rate of short-term dysphagia.
Granderath
Frank A
FA
Department of General, Visceral, and Transplant Surgery, University Hospital of Tübingen, Tübingen, Germany. fagzellamsee@yahoo.com
Kamolz
Thomas
T
Schweiger
Ursula M
UM
Pointner
Rudolph
R
D000328:Adult; D000368:Aged; D004947:Esophagus / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D006551:Hernia, Hiatal / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D010535:Laparoscopy; D008297:Male; D008365:Manometry; D008875:Middle Aged; D010528:Peristalsis; D011312:Pressure; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000295:instrumentation*; D013526:Surgical Mesh; D016896:Treatment Outcome