LONG-TERM EFFICACY OF 180-DEGREES ANTERIOR FUNDOPLICATION FOR SEVERE GASTROESOPHAGEAL REFLUX DISEASE

Objective: To evaluate the long-term efficacy and safety of 180-degree s anterior fundoplication in the treatment of gastro-oesophageal reflu x disease which does not respond to medical therapy or is complicated. Design: Prospective study. Setting: Institutional tertiary medical ce ntre. Patients: Eighty-six patients with acid reflux disease demonstra ted by standard acid reflux test and/or endoscopy were included in the study. The indication for surgery was failure of medical therapy in 6 3 cases and the presence of complications of acid reflux in 23 patient s. Interventions: All patients underwent an anterior 180-degrees fundo plication as the treatment for acid reflux. Measurements: Patients wer e evaluated before surgery and after a median follow-up of 9 years to assess their clinical status. Oesophageal manometry and ambulatory 24- h recording of oesophageal pH were performed in 44 patients at the tim e of the long-term evaluation. Results: No cases with gas-bloat syndro me or prolonged dysphagia were detected. Clinical relapse of acid refl ux occurred in eight patients; recording of pH was positive in five. T he pressure and the abdominal length of the lower oesophageal sphincte r significantly increased after surgery. Conclusions: Anterior 180-deg rees fundoplication is a safe and effective surgical technique in the treatment of severe gastro-oesophageal reflux disease.