MODIFIED NISSEN FUNDOPLICATION FOR REDUCTION OF FUNDOPLICATION FAILURE

Failure of the Nissen fundoplication can be secondary to disruption of the wrap or slippage of the stomach upward within the wrap. A modific ation of the Nissen fundoplication was devised and implemented between 1982 and 1995 to eliminate these complications. This report describes the modification and the results. Commonly. the Nissen fundoplication uses a single anterior row of sutures securing the wrapped stomach to the esophagus. This modification reinforces the wrap with two additio nal rows of suture, one right lateral and one left lateral, each furth er anchoring the wrapped stomach to the esophagus. This retrospective analysis compares the Nissen and modified Nissen fundoplications perfo rmed at our institution. Fundoplication operations were considered a f ailure if they required a reoperation secondary to wrap disruption or stomach slippage. Data were analysed using the chi(2) method. A total of 948 fundoplication procedures were performed; 326 Nissen and 622 mo dified Nissen. Follow-up ranged from 0.5 to 13 years (mean, 6 years). Thirteen wrap disruptions and six stomach slippages occurred in the Ni ssen group (5.8%); 10 wrap failures and no stomach slippages occurred in the modified Nissen group (1.6%), P <.05. The authors conclude that this modification of the Nissen fundoplication significantly reduces wrap disruptions and stomach slippages. Copyright (C) 1997 by W.B. Sau nders Company.