2 ANTIREFLUX OPERATIONS - FLOPPY VERSUS STANDARD NISSEN FUNDOPLICATION

The effects of fundic mobilization in Nissen fundoplication on belchin g ability, abdominal gas volume, bloating and flatus were assessed in a prospective, randomized study of 25 patients with refractory gastro- oesophageal reflux disease. Reflux was cured regardless of fundic mobi lization. Subjective ability to belch was restored to preoperative in 73% of the patients with fundic mobilization, compared to 50% without. About 10% in both groups totally lost their ability to belch, Disturb ance from flatus increased postoperatively slightly in both groups, bu t from bloating it remained the same or even diminished. The residual intra-abdominal radioactivity (median (interquartile range)) after pro voked belching was preoperatively 8.9% (4.4-12.0) with and 13.2% (6.8- 15.2) without fundic mobilization, compared to 36.7% (31.1-40.9) of th e controls (P<0.05). After fundoplication this residual activity was n ormalized in both study groups. Disturbance from postoperative bloatin g or flatus were not related to the ability of belching, Preoperativel y symptomatic patients tended to have more complaints postoperatively. In conclusion, fundic mobilization restored belching ability slightly more effectively without compromising antireflux efficacy, but there did not seem to be any advantage regarding flatus or bloating.