Open Nissen fundoplication and highly selective vagotomy as a treatment for gastro-oesophageal reflux disease

Background: Open Nissen fundoplication has been the most common surgical tr eatment of gastro-oesophageal reflux disease (GORD). The present paper desc ribes the symptomatic result, and quantifes the acid reduction achieved by open Nissen fundoplication combined with highly selective vagotomy (HSV) in a consecutive case series. Methods: A study of 106 patients undergoing open Nissen fundoplication and HSV for CORD was performed between 1988 and 1996. A history consistent with reflux was obtained and the diagnosis confirmed with ambulatory oesophagea l pH studies and endoscopy. Postoperative pH studies were performed, and pe ri-operative and Late complications were recorded. A standard questionnaire was sent out to patients postoperatively to assess the efficacy of surgery . Results: Pre-operative pH studies were performed on 104 (98%) patients. and on 97 (91.5%) following surgery. There was a highly significant improvemen t in all parameters of the pH study postoperatively. All symptoms, includin g bloating and dysphagia, improved significantly postoperatively, except fl atulence. which was exacerbated. The majority of patients were very satisfi ed with their outcome, 82% rating the operation from 80 to 100% successful. Complications were rare and there was no mortality. Conclusions: Open Nissen fundoplication and HSV is an effective method of t reating GORD, producing an improvement in symptoms and in ambulatory pH stu dies.