Abstracts
1999 Digestive Disease Week

# 2106 IS TOTAL FUNDOPLICATION POSSIBLE IN PATIENTS WITH GASTROESOPHAGEAL REFLUX (GER) AND DEFECTIVE PERISTALSIS?
Thomas R Eubanks, P Omelanczuk, Santiago Horgan, C Richards, D Pohl, C A Pellegrini, Univ of Washington, Seattle, WA

Partial fundoplication has traditionally been indicated for patients with GER who have defective peristalsis (DP), however recent studies suggest that it may be less effective than total fundoplication to control GER. We tested the hypothesis that a floppy total fundoplication could be performed in patients with DP without causing dysphagia.
Methods: We performed total fundoplication in 12 consecutive patients with DP (distal amplitude < 30 mmHg or failed propagation in more than 60% of swallows) and compared clinical and physiologic outcomes to 36 patients previously treated with partial fundoplication. All data was prospectively collected. Symptoms (on a scale of 0-4) were evaluated through a standard questionnaire before and after the operation. Manometry and 24 h pH monitoring were done in all patients preoperatively and in 16 patients postoperatively. Statistical analysis was performed using a Student t-test for continuous data. The Wilcoxan-signed Ranks and Mann-Whitney U tests were use to analyze symptom scores.
Results: Mean follow up was 21 months (range 8 to 38 months). Symptom scores, contraction amplitude and acid exposure were as follows:
Conclusion: Our study shows that both partial and total fundoplication were effective to control GER. Furthermore, both operations improved the amplitude of contractions in the esophagus. Patients with DP can be safely treated by either operation without fear of causing dysphagia.

	Heartburn		Dysphagia		Contraction Amplitude	Peristalsis	Acid Exposure
	pre	post	pre	post	(% increase)	(% increase)	(% decrease)
Partial Fundoplication	3.9*	0.8*	1.0	0.5*	180*	9.4	81*
Total Fundoplication	3.6	0*	1.5	0*	30*	4.1	79*

Copyright 1996 - 1999, SSAT, Inc.