Gl. Dunnington et al., OUTCOME EFFECT OF ADHERENCE TO OPERATIVE PRINCIPLES OF NISSEN FUNDOPLICATION BY MULTIPLE SURGEONS, The American journal of surgery, 166(6), 1993, pp. 654-658
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.