EFFECT OF FUNDAL MOBILIZATION IN NISSEN-ROSSETTI FUNDOPLICATION ON ESOPHAGEAL TRANSIT AND DYSPHAGIA - A PROSPECTIVE, RANDOMIZED TRIAL

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.