FATE OF NISSEN FUNDOPLICATION AFTER 20 YEARS - A CLINICAL, ENDOSCOPIC, AND FUNCTIONAL-ANALYSIS

Of 46 patients who had Nissen fundoplication for proved gastro-oesopha geal reflux, 25 were available for follow up after a median of 20 year s, 15 had died of unrelated causes, and six could not be traced. All 2 5 patients in the follow up study were personally interviewed: 21 cons ented to an endoscopy, 14 to 24 hour recording of oesophageal pH and m anometry, and 15 to radionuclide transit test. Repeat fundoplication f or recurrent reflux was performed in two cases during the study. Heart burn and regurgitation were significantly lessened (p<0.005), but the incidence of dysphagia was slightly increased. Endoscopy showed six of 21 fundic wraps to be defective. Erosive oesophagitis was seen in two patients, and Barrett's oesophagus (histologically confirmed) in one of them and six other patients. Total reflux time was abnormal in four of 14 patients. No patient with an intact fundic wrap seen on endosco py, only two of seven with Barrett's oesophagus, and one of four with abnormal reflux had oesophagitis. Fundoplication in itself did not aff ect oesophageal motility or transit, provided that the wrap was intact . It is concluded that Nissen fundoplication gave a reasonably good lo ngterm effect in chronic reflux disease, with the state of the fundic wrap as the main determinant of outcome.