LONG-TERM RESULTS OF A PROSPECTIVE RANDOMIZED COMPARISON OF TOTAL FUNDIC WRAP (NISSEN-ROSSETTI) OR SEMIFUNDOPLICATION (TOUPET) FOR GASTROESOPHAGEAL REFLUX

The importance of the extent of the fundic wrap that encircles the dis tal oesophagus for the establishment of long-term control-of gastro-oe sophageal reflux disease (GORD) and for the risk of symptoms after fun doplication was evaluated ill a prospective, randomized clinical trial , Of 137 consecutive patients with GORD, 72 were allocated to a semifu ndoplication (180-200 degrees, Toupet) and 65 tea: total fundoplicatio n (360 degrees, Nissen-Rossetti)I Dysphagia was more common in the ear ly postoperative period after a total fundic wrap, a difference which disappeared with time. This corresponded to a higher resting tone in t h lower oesophageal sphincter area. Seven patients (5 percent) experie nced relapse of GORD during follow-up of of more than 3 gears. Althoug h no re difference in the cumulative: relapse rate (5 per cent for Nis sen-Rossetti versus 6 per cent for Toupet) was found between the two s tudy groups, the total failure rate was higher (P < 0.05) among patien ts who had a Nissen-Rossetti procedure because of a procedure-specific complication: intrathoracic herniation of the fundoplication in five patients caused obstructive symptoms without reflux (four had no poste rior crural repair). in. addition, symptoms in the form of flatulence were more frequently seen after Nissen-Rossetti fundoplication (P < 0. 05 at 2 years and P < 0.01 at 3 years), Both Nissen-Rossetti and Toupe t fundoplication equally well and durably controlled GORD, Few er symp toms occurred in those having a semifundoplication, both in the early and late postoperative period.