OUTCOME EFFECT OF ADHERENCE TO OPERATIVE PRINCIPLES OF NISSEN FUNDOPLICATION BY MULTIPLE SURGEONS

Fifty-eight patients participated in a multi-institutional study desig ned to assess the outcome of Nissen fundoplication when performed for complicated disease by a variety of surgeons with varied skill and exp erience with compliance to established technical principles. All patie nts had an abnormal 24-hour pH study and mucosal injury on endoscopy. The surgical procedures were performed in 8 Veterans Administration ho spitals by surgical residents supervised by surgical faculty, after in itial agreement on 10 operative principles for the Nissen fundoplicati on. The mean symptomatic scores at 52 and 104 weeks improved significa ntly compared with the preoperative score (p <0.0001). There was signi ficant improvement in total percent time at pH below 4 at 52 weeks (p <0.01) and 104 weeks (p <0.01). There was significant improvement in t he grade of esophagitis at 1 year (p <0.0001). Compliance was greater than 90% for 7 of 10 principles of repair. In conclusion, a Nissen fun doplication resulted in relief of symptoms in 93% of patients and a 77 % rate of healing of esophagitis. These results in complicated reflux disease were achieved by a variety of surgeons with varied experience in antireflux surgery.