title: Novel surgical concept in antireflux surgery: long-term outcomes comparing 3 different laparoscopic approaches.
abstract: BACKGROUND
  The Nissen fundoplication procedure is the most widely used type of antireflux surgery. The results are not always as good as expected, and several modifications to the original technique have been proposed. Long-term effectiveness studies comparing different techniques of antireflux surgery are limited. Our group developed a new concept in antireflux surgery (complete fixed "nondeformable" fundoplication) in order to improve its outcome; we present the long-term comparative results of this novel concept/technique.
  
  
  METHODS
  Overall, 512 patients were included in the study and assigned into 1 of 3 fundoplications groups: partial (131), Nissen (133), and fixed "nondeformable" (121). We compared the groups with each other and with a group who chose to receive medical treatment (MT) (127). All patients underwent clinical evaluation, upper gastrointestinal endoscopy, esophageal manometry, 24-hour esophageal pH monitoring, and the SF-36 health status survey prior to operation and at 1, 5, 10, and 15 years of follow-up.
  
  
  RESULTS
  At the 15-year follow-up, we were able to complete the protocol in 319 patients: 103 patients from the partial group, 102 patients from the Nissen group, 97 patients from the fixed "nondeformable" group, and 17 patients from the medical treatment group. A lower prevalence of erosive gastroesophageal reflux disease (GERD) was observed in the fixed "nondeformable" group (7.20%) versus 21.56% for Nissen, 39.80% for partial, and 47.05% for MT (P < .01). Lower esophageal sphincter (LES) pressure and LES length were more constant in the fixed "nondeformable" group (14.7 mm Hg/2.2 cm) compared with the Nissen (9 mm Hg/0.7 cm), partial (7 mm Hg/2 cm), and MT (5.64 mm Hg/1.3 cm) groups (P < .01). Reflux recurrence was observed in 168 patients (13 in fixed "nondeformable," 41 in Nissen, and 98 in partial (P < .01).
  
  
  CONCLUSIONS
  The complete fixed "nondeformable" fundoplication showed best results in studied parameters and had a lower long-term recurrence compared with Nissen and partial techniques.
authors.affiliation: Department of Endoscopic Surgery, National Institute of Nutrition and Medical Sciences Salvador Zubirán, Mexico City, Mexico. mucio@redmedicasur.org.mx
authors.forename: Moreno
authors.initials: M
authors.lastname: Mucio
authors.forename: Martin
authors.initials: M
authors.lastname: Rojano
authors.forename: Jose Jesus
authors.initials: JJ
authors.lastname: Herrera
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Valdovinos
authors.forename: J Ángel
authors.initials: JÁ
authors.lastname: Córdova
authors.forename: Carlos
authors.initials: C
authors.lastname: Bravo
authors.forename: Luis
authors.initials: L
authors.lastname: Dominguez
authors.forename: Oscar
authors.initials: O
authors.lastname: Sanchez
mesh_terms: D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008365:Manometry; D059035:Perioperative Period; D011446:Prospective Studies; D011788:Quality of Life; D012008:Recurrence; D016896:Treatment Outcome