Background: Fundoplication operations have documented their efficacy in the long-term management of gastroesophageal reflux disease (GERD). Two significant issues remain, one is that only a few prospective controlled series support the long-term efficacy of these procedures (>10 years) and secondly further data are required to assess if different fundoplication procedures are associated with varying frequency of post fundoplication complaints.
Aims: To assess the long-termfunctional outcome and level of efficacy of an open partial posterior fundoplication compared to total fundic wrap within the framework of a controlled, randomized clinical trial protocol.
Patients and methods: During the years 1983-1991 137 chronic GERD patients were enrolled of whom 72 were randomized to a semifundoplication and 65 to a total fundoplication. The patients were followed-up by use of standardized symptom assessments, endoscopy and 24 pH monitoring. 107 patients completed a medium follow-up of 11.5 years and during this period 7 had had a reoperation (5 Nissen-Rossetti and 2 Toupét), 10 patients had died and 12 were lost to follow-up or did not accept to be followed up. Among the studied patients 53 had a total wrap and 54 a partial posterior fundoplication.
Results: Heartburn control was attained in 88% and 92% in the total and partial fundoplication group, respectively and the corresponding figure for control of acid regurgitation were 90 and 94%, respectively. We observed no difference in dysphagia scoring although odynophagia was somewhat more frequently reported in those having a total fundoplication. On the other hand a significant difference was observed in the prevalence of rectal flatus and postprandial fullness which was significantly more often recorded in those having a total fundoplication (p<0.05 and p<0.02 respectively).
Conclusions: A posterior partial fundoplication seems to offer the same high and maintained level of reflux control as a total fundoplication. Earlier observations over the advantages of a partial fundoplication, with less gas-bloat associated complaints have now been extended to remain even after >10 years of follow-up.