PARIETAL-CELL VAGOTOMY PERFORMED WITH FUNDOPLICATION FOR ESOPHAGEAL REFLUX

BACKGROUND: Reduction of acid secretion is an important aspect of medi cal treatment of reflux esophagitis. Truncal vagotomy and drainage pro cedures used in conjunction with antireflux procedures to reduce acid secretion in patients with gastroesophageal reflux were unsatisfactory . This study reviews the results of parietal cell vagotomy used in con junction with a 360-degree fundoplication to determine if reduction of acid by this form of vagotomy was beneficial to patients with gastroe sophageal reflux. METHODS: Between March 1973 and May 1993, 94 private and 64 Veterans Administration patients underwent parietal cell vagot omy and Nissen type fundoplication for esophageal reflux. Esophagogast roduodenoscopy (EGD), gastric analysis, cine-esophagogram, and 24-hour esophageal pH and motility studies were performed preoperatively on V A patients. Private patients underwent EGD, cine-esophagogram, and som etimes pH and motility studies. Similar studies were performed postope ratively if the patient permitted. The major technical alteration made during the study was the addition of posterior gastropexy to the oper ations performed between March 1978 and January 1987. Patients were co nsidered failures if dysphagia and reflux symptoms were moderate but o peration not contemplated (Visick III) or symptoms were severe and reo peration had been performed or was contemplated (Visick IV). RESULTS: There were no operative deaths. There were 25 operative failures; dysp hagia contributed to failure in 4, reflux in 11, and dysphagia and ref lux in 10 patients. Reoperation was required in 6 patients. There was no statistical difference in acid secretion inhibition for patients wi th or without postoperative reflux symptoms. The cumulative probabilit y for operative failure was 9.3 +/- SE 4.2% for patients who underwent posterior gastropexy and 22.9 +/- SE 4.6% (P <0.02) for those who did not. CONCLUSIONS: Parietal cell vagotomy with Nissen fundoplication i s a safe operation. The exposure created by PCV protected the vagi fro m injury, The study design made it impossible to determine whether PCV improved the results of fundoplication but the failure rate was signi ficantly (P <0.02) reduced by the addition of posterior gastropexy. Th is may have lessened the risk of disintegration of the wrap that might be more likely to occur after PCV. (C) 1997 by Excerpta Medica, Inc.