Abstracts
1999 Digestive Disease Week

# 2105 IN PATIENTS WITH POOR ESOPHAGEAL MOTILITY, 360O FUNDOPLICATION CAUSES NO MORE DYSPHAGIA THAN 270O FUNDOPLICATON
Stephen B. Archer, Timothy M. Farrell, Emory Univ Sch of Medicine, Atlanta, GA; Gene J. Branum, C. Daniel Smith, Emory Univ, Atlanta, GA; John G. Hunter, Emory Univ Sch of Medicine, Atlanta, GA

Introduction 270° posterior fundoplication (FN)(Toupet) is often utilized in patients with poor esophageal motility (EM), because of a presumed reduction in postoperative dysphagia when compared to 360° FN (Nissen). However, 270° FN may not provide as effective an antireflux barrier.
Methods In order to determine whether a 360° FN was associated with more dysphagia than 270° FN, we reviewed pre- and postoperative symptom scores in patients with normal and abnormal EM. Abnormal EM was defined as esophageal body pressure of less than 30mm Hg or peristalsis less than 70% of 10 wet swallows. Patients graded dysphagia preoperatively, and at 6 weeks and 12 months postoperatively using a four point symptom severity score {0 (none)-3 (severe)}. Patients with achalasia, paraesophageal hernia, previous antireflux operations, or absent EM were omitted. Data was analyzed with the Wilcoxon Signed Ranks and Mann-Whitney tests.
Results 445 patients met the above criteria. 399 of these had follow-up data adequate for statistical analysis. 350 patients had normal EM and a 360o FN. 12 patients with normal EM underwent 270o FN. 15 patients with abnormal EM underwent 360o FN, and 22 patients with abnormal EM underwent 270o FN. Median follow-up was 27.5 months (2-59). There was no difference in dysphagia symptom scores between the groups undergoing 270o FN and 360o FN, either preoperatively or at any time postoperatively, regardless of EM status.
Conclusion Patient outcomes for dysphagia are no different for 360o or 270o FN even in the presence of abnormal EM. It may not be necessary to perform a 270° FN in patients with poor EM.

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