Summary
A series of 50 patients was studied by esophageal manometry and X-ray prior to fundoplication and for a three month thereafter. In 49 patients a functionally intact gastroesophageal junction was documented; in one patient disintegration of the plication occured. The resting pressure of the lower esophageal sphincter was found preoperatively in the range of 10,4 ± 3,7 mm Hg; postoperative values increased to 19,0 ± 6,9 mm Hg. 10 % of patients complained postoperatively of temporary dysphagia. Only in a single instance continued dysphagia had to be treated. Inadvertently two patients were vagotomized during the operation. The data are discussed in relevance to the technical details of the operative procedure.
Zusammenfassung
Zur Überprüfung der klinischen Ergebnisse der Fundoplicatio wurde eine Serie von 50 Patienten nach exakter Dokumentation der präoperativen Befunde manometrisch und röntgenologisch 3 Monate postoperativ nachuntersucht. Bei 49 Patienten konnte ein funktionsfähiger gastrooesophagealer Verschluß aufgezeigt werden; in einem Fall hatte sich die Fundusmanschette gelöst. Die präoperativ deutlich erniedrigten Ruhedrucke im unteren Oesophagussphincter (10,4 ± 3,7 mm Hg) konnten durch die Operation auf 19,0 ± 6,9 mm Hg angehoben werden. In 10% der Fälle bestanden unmittelbar postoperativ passagere Dysphagien, die sich in der Regel rasch zurückbildeten. Nur bei einem Patienten mußte eine persistierende Dysphagie behandelt werden. Zwei weitere Patienten waren intraoperativ unbeabsichtigt vagotomiert worden. Diese Ergebnisse werden im Hinblick auf ihre operativtechnischen Konsequenzen diskutiert.
Similar content being viewed by others
Literatur
Balison, J. R., Woodward, E. R.: Effect of hiatus hernia repair and truncal vagotomy on humans lower esophageal sphincter pressures. Ann. Surg.177, 554 (1973)
Battle, W. S., Nyhus, L. M., Bombeck, C. T.: Gastroesophageal reflux. Ann. Surg.177, 560 (1973)
Battle, W. S., Nyhus, L. M., Bombeck, C. T.: Nissen fundoplication and esophagitis secondary to gastroesophageal reflux. Arch. Surg.106, 588 (1973)
Behar, J., Biancani, P., Spiro, H. M., Storer, E. H.: Effect of fundoplication on lower esophageal sphincter (LES) competence. Gastroenterology67, 209–215 (1973)
Cohen, W. N.: The fundoplication repair of sliding esophageal hiatus hernia, its roentgenol graphic appearance. Amer. J Roentgennol.104, 625–631 (1968)
Csendez, A., Larrain, A.: Effect of posterior gastropexy on gastroesophageal sphincter pressure and symptomatic reflux in patients with hiatal hernia. Gastroenterology63, 19–24 (1972)
Denck, H.: Erfahrungsbericht über 500 Operationen wegen Hiatushernie und deren Folgezustände. Leber, Magen, Darm2, 59–61 (1972)
Ellis, F. H., Garabedian, M., Gibbi, S. B.: Fundoplication for gastroesophageal reflux. Arch. Surg.107, 186 (1973)
Farrell, R. L., Higgs, R. H., Castelli, D. O.: Dynamics of the lower esophageal high pressure zone before and after Belsey fundoplasty. Gastroenterology66, 690 (1974)
Hill, L. D.: Surgery and gastroesophageal reflux. Gastroenterology63, 183–185 (1972)
Lind, J. F., Burns, C. M., MacDougall, J. T.: Physiological repair for hiatus hernia, manometric study. Arch. Surg.91, 233–237 (1965)
Lipshutz, W. H., Eckert, R. J., Lukash, W. M.: A critical evaluation and comparison of the surgical treatment of gastroesophageal reflux. Gastroenterology66, 853 (1974)
Menguy, R.: Choice of operations in the management of symptomatic sliding hiatal hernia. Ann. Rev. Med.23, 313–320 (1972)
Moran, J. M., Pihl, C. O., Norton, R. A., Rheinlander, H. F.: The hiatal hernia reflux complex current approaches to correction. Amer. J. Surg.121, 403–411 (1971)
Naef,A. P., Savary, M., Jaques, W. A.: L'efficacité de la fundoplicatio dans le traitement du reflux et de l'oesophagite peptique. Schweiz. med. Wschr.100, 1228 (1970)
Pearson, F. G., Langer, B., Henderson, R. D.: Gastroplasty and Belsey hiatus hernia repair an operation for the management of peptic stricture with acquired short esophagus. J. thorac. cardiovasc. Surg.61, 50–63 (1971)
Peiper, H.-J., Siewert, J. R.: Aktuelle Aspekte in der Chirurgie der Hiatushernie. Dtsch. med. Wschr.98, 1131–1136 (1973)
Polk, H. C., Zeppa, R.: Fundoplication for complicated hiatal hernia. Ann. thorac. Surg.7, 202–211 (1969)
Rossetti, M., Allgöwer, M.: Fundoplication for treatment of hiatal hernia. Progr. Surg. (Basel)12, 1 (1973)
Shah, I. K., Daniel, O.: The results of fundoplication for the relief of esophageal reflux due to hiatal hernia. Brit. J. Surg.59, 285 (1972)
Siewert, J. R.: Der Endobrachyoesophagus. Chirurg45, 245 (1974)
Siewert, J. R., Weiser, F., Jennewein, H. M., Waldeck, F.: Clinical and manometric investigations of the lower esophageal sphincter and its reactivity to pentagastrin in patients with hiatal hernia. Digestion10, 287–298 (1974)
Siewert, J. R., Jennewein, H. M., Waldeck, F.: Mechanism of action of fundoplication. Proc. of the IV. Int. Symp. on Gastroint. Motility, p. 145. Mitchell Press 1974
Siewert, J. R., Jennewein, H. M., Waldeck, F., Peiper, H.-J.: Experimentelle und klinische Untersuchungen zum Wirkungsmechanismus der Fundoplicatio. Langenbecks Arch. Chir.333, 5–21 (1973)
Skinner, D. B., Belsey, R. H.: Surgical management of esophageal reflux and hiatus hernia; long term results with 1030 patients. J. thorac. cardiovasc. Surg.53, 33–54 (1967)
Skinner, D. B., Booth, J. D.: Assessment of distal esophageal function in patients with hiatal hernia or gastroesophageal reflux. Ann. Surg.172, 627–637 (1970)
Thomas, H. F. et al.: Results of the combined fundic patch — fundoplication operation in the treatment of reflux esophagitis with stricture. Surg. Gynec. Obstet.135, 241–245 (1972)
Waldeck, F., Jennewein, H. M., Siewert, J. R.: The continous withdrawal method for functional analysis of the lower esophageal sphincter in man. Europ. J. clin. Invest.3, 331 (1973)
Widmer, A.: Erfahrungen mit der Fundoplicatio. Langenbecks Arch. klin. Chir.322, 416–418 (1968)
Woodward, E. D., Thomas, H. F., Macalhany, J. C.: Comparison of crural repair and Nissen fundoplication in the treatment of esophageal hiatal hernia with peptic esophagitis. Ann. Surg.171, 782–789 (1971)
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Siewert, R., Wallat, H.J., Krtsch, H. et al. Klinische Ergebnisse der Fundoplicatio. Langenbecks Arch Chiv 338, 9–26 (1975). https://doi.org/10.1007/BF01302723
Received:
Issue Date:
DOI: https://doi.org/10.1007/BF01302723