Mes. Luostarinen et al., EFFECT OF FUNDAL MOBILIZATION IN NISSEN-ROSSETTI FUNDOPLICATION ON ESOPHAGEAL TRANSIT AND DYSPHAGIA - A PROSPECTIVE, RANDOMIZED TRIAL, The European journal of surgery, 162(1), 1996, pp. 37-42
Objective: To assess the effect on postoperative dysphagia and oesopha
geal transit of fundal mobilisation during Nissen-Rossetti fundoplicat
ion. Design: Prospective, randomised study. Setting: University Hospit
al, Finland. Subjects: 20 consecutive patients with confirmed gastro-o
esophageal reflux who were referred for antireflux surgery. Interventi
ons: Fundoplication with either conventional Nissen-Rossetti procedure
or an otherwise identical technique incorporating total fundal mobili
sation (n = 10 in each group). Main outcome measures: Recurrent or per
sistent symptoms of dysphagia, and the oesophageal transit time of a l
iquid bolus labelled with radioactive nuclide. Results: In both groups
excellent relief of heartburn and regurgitation was achieved (only 2
patients in each group reported occasional symptoms), one patient had
oesophagitis, and the pH returned to the normal range. The incidence o
f dysphagia was similar in both groups by 6 months postoperatively, bu
t there was significant, though transient, impairment of oesophageal t
ransit after fundal mobilisation (p = 0.03). Conclusions: Fundal mobil
isation did not seem to confer any advantage as fas as the incidence o
f postoperative dysphagia was concerned. On the contrary, it was assoc
iated with transient disturbance in the oesophageal transit time of a
liquid bolus. Longer follow up is needed to show if this impairment is
of any clinical relevance.