Advertisement

Complete Versus Partial Fundoplication

  • L. Lundell

Concluding remarks

With the aim of optimising the outcome of antireflux surgery, the surgeon has to perform and master a delicate act of balance on the choice between various fundoplication procedures. On one hand we have the total fundoplication with its proved efficacy regarding reflux control but with it associated mechanical side-effects leading to symptoms relating to the relative obstruction in the gastroesophageal junction and the inability to vent air from the stomach and the sequelae that follow. The posterior partial fundoplication has obvious advantages with less postfundoplication complaints without compromising with the level of reflux control and can therefore be generally recommended. Some anterior partial fundoplication present very promising results but confirmative studies are warranted.

Keywords

Lower Esophageal Sphincter Lower Esophageal Sphincter Pressure Esophageal Acid Exposure Laparoscopic Fundoplication Partial Fundoplication 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. [1]
    Nissen R (1956) Eine einfache Operation zur Beeinflussung der Reflux Oesophagitis. Schweiz Med Wochenschr 86: 590PubMedGoogle Scholar
  2. [2]
    Watson DI, Jamieson GG (1998) Antireflux surgery in the laparoscopic era. Br J Surg 85(9): 1173–1184PubMedCrossRefGoogle Scholar
  3. [3]
    Perdikis G, Hinder RA, Lund RJ, Raiser F, Katada N (1997) Laparoscopic Nissen fundoplication: where do we stand? Surg Laparosc Endosc 7: 17–21PubMedCrossRefGoogle Scholar
  4. [4]
    Peracchia A, Bancewicz J, Bonavina L et al (1995) Fundoplication is an effective treatment for gastro-oesophageal reflux disease. Gastroenterol Int 8: 1–7Google Scholar
  5. [5]
    Anvari M, Allen C, Borm A (1995) Laparoscopic Nissen fundoplication is a satisfactory alternative to long-term omeprazole therapy. Br J Surg 82: 938–942PubMedGoogle Scholar
  6. [6]
    Watson DI, Jamieson GG, Baigrie RJ et al (1996) Laparoscopic surgery for gastro-oesophageal reflux: beyond the learning curve. Br J Surg 223: 1284–1287CrossRefGoogle Scholar
  7. [7]
    Laine S, Rantala A, Gullichsen R, Ovaska J (1997) Laparoscopic vs conventional Nissen fundoplication. A prospective randomized study. Surg Endoscopic 11: 441–444CrossRefGoogle Scholar
  8. [8]
    Nilsson G, Larsson S, Johnsson F (2000) Randomized clinical trial of laparoscopic versus open fundoplication: blind evaluation of recovery and discharge period. Br J Surg 87: 873–878PubMedCrossRefGoogle Scholar
  9. [9]
    DeMeester, Bonavina L, Albertucci M (1986) Nissen fundoplication for gastroesophageal reflux disease. Evaluation of primary repair in 100 consecutive patients. Ann Surg 204: 9–20PubMedGoogle Scholar
  10. [10]
    Luostarinen M, Isolauri J, Laitinen J, Koskinen M, Keyriläinen O, Markkula H, Lehtinen E, Uusitalo A (1993) Fate of Nissen fundoplication after 20 years. A clinical, endoscopical and functional analysis. Gut 34: 1015–1020PubMedGoogle Scholar
  11. [11]
    Negre JB, Markkula HT, Keyriläinen O, Matikainen (1983) Nissen fundoplication. Results at 10-year follow-up. Am J Surg 146: 635–638PubMedCrossRefGoogle Scholar
  12. [12]
    Garstin WI, Hohnston GW, Kennedy TL, Spencer ES (1986) Nissen fundoplication: the unhappy 15%. Royal Coll Surg Edinburgh 31: 207Google Scholar
  13. [13]
    Lundell L, Abrahamsson H, Ruth M, Rydberg L, Lönroth H, Olbe L (1996) Long-term results of a prospective randomised comparison of total fundic wrap (Nissen-Rossetti) or semifundoplication (Toupét) for gastro-esophageal reflux. Br J Surg 83(6): 830–835PubMedGoogle Scholar
  14. [14]
    Toupét A (1963) Technique d’oesopgago-gastroplastie avec phre’nogastropexie appliquée dans la crure radicale des hernies hiatales et comme complément de l’operation d’Heller dans les cardiospasmes. Mem Acad Chir 89: 394–398Google Scholar
  15. [15]
    Walker SJ, Holt S, Sanderson CJ, Stoddard CJ (1992) Comparison of Nissen total and Lind partial transabdominal fundoplication in the treatment of gastro-oesophageal reflux. Br J Surg 79: 410–414PubMedGoogle Scholar
  16. [16]
    Watson A, Jenkinson LR, Ball CS, Barlow AP, Norris TL (1991) A more physiological alternative to total fundoplication for the surgical correction of resistant gastro-oesophageal reflux. Br J Surg 78: 1088–1094PubMedGoogle Scholar
  17. [17]
    Orlando RC (1997) The pathogenesis of gastroesophageal reflux disease: the relationship between epithelial defense, dysmotility, and acid exposure. Am J Gastroenterol 92: 3S–5SPubMedGoogle Scholar
  18. [18]
    Orlando RC, Bryson JC, Powell DW (1984) Mechanisms of H+ injury in rabbit esophageal epithelium. Am J Physiol 246: G718–G724PubMedGoogle Scholar
  19. [19]
    Mittal RK, Balaban DH (1997) The esophagogastric junction. N Engl J Med 336: 924–932PubMedCrossRefGoogle Scholar
  20. [20]
    Dodds WJ, Dent J, Hogan WJ, Helm JF, Hauser R, Patel GK et al (1982) Mechanisms of gastroesophageal reflux in patients with reflux esophagitis. N Engl J Med 307: 1547–1552PubMedCrossRefGoogle Scholar
  21. [21]
    Dent J (1976) A new technique for continuous sphincter pressure measurement. Gastroenterology 71: 263–267PubMedGoogle Scholar
  22. [22]
    Holloway RH, Hongo M, Berger K, McCallum RW (1985) Gastric distension: a mechanism for postprandial gastroesophageal reflux. Gastroenterology 89: 779–784PubMedGoogle Scholar
  23. [23]
    Holloway RH, Kocyan P, Dent J (1991) Provocation of transient lower esophageal sphincter relaxations by meals in patients with symptomatic gastroesophageal reflux. Dig Dis Sci 36: 1034–1039PubMedCrossRefGoogle Scholar
  24. [24]
    Wyman JB, Dent J, Heddle R, Dodds WJ, Toouli J, Downton J (1990) Control of belching by the lower oesophageal sphincter. Gut 31: 639–646PubMedGoogle Scholar
  25. [25]
    Martin CJ, Patrikios J, Dent J (1986) Abolition of gas reflux and transient lower esophageal sphincter relaxation by vagal blockade in the dog. Gastroenterology 91: 890–896PubMedGoogle Scholar
  26. [26]
    Scheffer RCH (2004) New insights into esophago-gastric junction physiology. Thesis University of Utrecht, Febodruk BV, Enschede, The NetherlandsGoogle Scholar
  27. [27]
    Scheffer RC, Tatum RP, Akkermans LM, Joehl RJ, Kahrilas PJ (2003) Reduced tLESR elicitation in response to gastric distension in fundoplication patients. Am J Phys Gastrointest Liver Physiol 284: G815–G820Google Scholar
  28. [28]
    Sifrim D, Holloway R, Silny J, Tack J, Lerut A, Janssens J (2001) Composition of the postprandial refluxate in patients with gastroesophageal reflux disease. Am J Gastroenterol 96: 647–655PubMedCrossRefGoogle Scholar
  29. [29]
    Lindeboom MYA, Vu MK, Ringers J, van Rijn PJJ, Neijenhuis P, Masclee AAM (2003) Function of the proximal stomach after partial versus complete laparoscopic fundoplication. Am J Gastroent 98(2)Google Scholar
  30. [30]
    DeMeester TR, Stein HJ (1992) Minimizing the side effects of antireflux surgery. World J Surg 16: 335–336.PubMedCrossRefGoogle Scholar
  31. [31]
    Watson DI, Mathew G, Pike GK, Baigrie RJ, Jamieson GG (1998) Efficacy of anterior, posterior and total fundoplication in an experimental model. Br J Surg 85: 1006–1009PubMedCrossRefGoogle Scholar
  32. [32]
    Vu MK, Straathof JW, Schaar PJ, Arndt JW, Ringers J, Lamers CB, Masclee AA (1999) Motor and sensory function of the proximal stomach in reflux disease and after laparoscopic Nissen fundoplication. Am J Gastroenterol 94: 1481–1489PubMedCrossRefGoogle Scholar
  33. [33]
    Bjerkestet T, Nordgaard K, Schjonsby H (1980) Effect of Nissen fundoplication operation on the lower esophageal sphincter. Scand J Gastroenterol 15: 213. DeMeester TR, Wernly JA, Brian GH et al (1979) Clinical and in vitro analysis of determinants of gastroesophageal competence. A study of principles of antireflux surgery. Am J Surg 137: 39CrossRefGoogle Scholar
  34. [34]
    Rydberg R, Ruth M, Lundell L (1999) Mechanism of action of antireflux surgery. Br J Surg 86: 405–410PubMedCrossRefGoogle Scholar
  35. [35]
    Ellis FH, Crozier RE (1984) Reflux control by fundoplication: a clinical and manometric assessment of the Nissen operation. Ann Thorac Surg 38: 387–392PubMedCrossRefGoogle Scholar
  36. [36]
    Watson A, Spychal RT, Brown MG, Peck N, Callender N (1995) Laparoscopic “physiological” antireflux procedure: preliminary results of a prospective symptomatic and objective study. Br J Surg 82: 651–656PubMedGoogle Scholar
  37. [37]
    Hunter JG, Trus TL, Branum GD, Waring JP, Wood WC (1996b) A physiologic approach to laparoscopic fundoplication for gastroesophageal reflux disease. Ann Surg 223: 673–687PubMedCrossRefGoogle Scholar
  38. [38]
    Laws HL, Clements RH, Swillie CM (1997) A randomised, prospective comparison of the Nissen fundoplication versus the Toupét fundoplication for gastroesophaeal reflux disease. Ann Surg 225: 647–654PubMedCrossRefGoogle Scholar
  39. [39]
    Horvath KD, Jobe BA, Herron DM, Swanstrom LL (1999) Laparoscopic Toupét fundoplications is an inadequate procedure for patients with severe reflux disease. J Gastrointest Surg: 583–591Google Scholar
  40. [40]
    Jobe BA, Wallace J, Hansen PD, Swanström LL (1997) Evaluation of laparoscopic Toupét fundoplication as a primary repair for all patients with medically resistant gastroesophageal reflux. Surg Endosc 11: 1080–1083PubMedCrossRefGoogle Scholar
  41. [41]
    Escandell AO, DeHaro LFM, Paricio PP, Albasini JLA, Marcilla JAG, Cuencea GM (1991) Surgery improves defective esophageal peristalsis in patients with gastroesophageal reflux. Br J Surg 78: 1095–1097Google Scholar
  42. [42]
    Rydberg L, Ruth M, Lundell L (1997) Does oesophageal motor function improve with time after successful antireflux surgery? Results of a prospective, randomised clinical study. Gut 41: 82–86PubMedCrossRefGoogle Scholar
  43. [43]
    Hinder A, Smith SL, Klinger PJ et al: Laparoscopic antireflux surgery — it’s a wrap. Dig Surg 16: 7–11Google Scholar
  44. [44]
    Loustarinen M, Koskinen M, Reinikainen P et al (1995) Two antireflux operations: floppy versus standard Nissen fundoplication. Ann Med 27: 199–205Google Scholar
  45. [45]
    Patterson EJ, Herron DM, Hansen PD, Ramzi N, Standage BA, Swanström LL (2000) Effect on an esophageal bougie on the incidence of dysphagia following Nissen fundoplication. Arch Surg 135: 1055–1062PubMedCrossRefGoogle Scholar
  46. [46]
    Hagedorn C, Lönroth H, Rydberg L, Ruth M, Lundell L (2002) Long-term efficacy of total (Nissen-Rossetti) and posterior partial (Toupet) fundoplication: result of a randomized clinical trial. J Gastroint Surg 4: 540–545CrossRefGoogle Scholar
  47. [47]
    Engström C, Blomqvist A, Dalenbäck J, Lönroth H, Ruth M, Lundell L (2004) Mechanical consequences of short gastric vessel division at the time of laparoscopic total fundoplication. J Gastroint Surg 4: 442–447CrossRefGoogle Scholar
  48. [48]
    de Beaux AC, Watson DI, O’Boyle C, Jamieson GG (2001) Role of fundoplication in patient symptomatology after laparoscopic antireflux surgery. Br J Surg 88: 117–1121Google Scholar
  49. [49]
    Tew S, Ackroyd R, Jamieson GG, Holloway RH (2000) Belching and bloating: facts and fantasy after antireflux surgery. Br J Surg 87: 477–481PubMedCrossRefGoogle Scholar
  50. [50]
    Wills VL, Hunt DR (2002) Dysphagia after antireflux surgery. Br J Surg 88: 486–499CrossRefGoogle Scholar
  51. [51]
    Bessell JR, Adair WD, Smithers BM, Menzies MB, Gotley DC (2002) Early reoperation for acute dysphagia following laparoscopic fundoplication. Br J Surg 89: 783–786PubMedCrossRefGoogle Scholar
  52. [52]
    del Pino Porres FJ, Sancho Fornos S, Benages Marinez A et al (2000) Manometric comprobation of esophagogastric junction competence after Nissen fundoplication and its relation to the length of fundic wrap. World J Surg 24: 870–873PubMedCrossRefGoogle Scholar
  53. [53]
    Hagedorn C, Jönsson C, Lönroth H et al (2003) Efficacy of an anterior as compared with a posterior laparoscopic partial fundoplication. Result of a randomized, controlled clinical trial. Ann Surg 238: 189–196PubMedCrossRefGoogle Scholar
  54. [54]
    Engström C (2004) Operations for gastro-oesophageal reflux disease — studies on mode of action and how to improve functional outcomes. Thesis, University of Göteborg, SwedenGoogle Scholar
  55. [55]
    Ireland AC, Holloway RH, Toouli J, Dent J (1993) Mechanisms underlying the anti-reflux action of fundoplication. Gut 34: 303–308PubMedGoogle Scholar
  56. [56]
    Johnsson F, Holloway RH, Ireland AC, Jamieson GG, Dent J (1997) Effect of fundoplication on transient lower oesophageal sphincter relaxation and gas reflux. Br J Surg 84: 686–689PubMedCrossRefGoogle Scholar
  57. [57]
    Lindboom MA, Ringers J, Straathof JW, van Rijn PJ et al (2003) Effect of laparoscopic partial fundoplication on reflux mechanisms. Am J Gastroenterol 98: 29–34CrossRefGoogle Scholar
  58. [58]
    O’Reilly MJ, Mullins SG, Saye WB, Pinto SE, Falkner PT (1996) Laparoscopic posterior partial fundoplication: analysis of 100 consecutive cases. J Laparoendosc Surg 6: 141–150PubMedGoogle Scholar
  59. [59]
    Cambell KL, Munro A (1998) Efficacy and incidence of post-fundoplication symptoms at a median of 5 years following open Watson fundoplication. Br J Surg 85(Suppl 1): 8Google Scholar
  60. [60]
    Watson DI, Liu J, Devitt PG, Game PA, Jamieson GG (2000) Outcome of laparoscopic anterior 180° partial fundoplication for gastroesophageal reflux disease. J Gastrointest Surg 4: 486–492PubMedCrossRefGoogle Scholar
  61. [61]
    Baxter ST, Walker SJ, Sutton R (1996) A randomised control trial of Nissen versus Lind fundoplication. Results of 10-year follow-up. In: Recent advances in diseases of the oesophagus (Perakia A, ed), pp 675–677. Monduzzi EditoreGoogle Scholar
  62. [62]
    DeMeester TR, Johnson LF, Kent AH (1974) Evaluation of cutrent operations for the prevention of gastroesophageal reflux. Ann Surg 180: 511–525PubMedGoogle Scholar
  63. [63]
    Segol P, Hay JM, Pottier D (1989) Surgical treatment of gastroesophageal reflux: which operation to choose: Nissen, Toupet or Lotart-Jacob? Gastroenterol Clin Biol 13: 873–879PubMedGoogle Scholar
  64. [64]
    Thor KBA, Silander T (1989) A long-term randomized prospective trial of the Nissen procedure versus a modified Toupet technique. Ann Surg 210: 719–724PubMedGoogle Scholar
  65. [65]
    Lundell L, Abrahamsson H, Ruth M, Sandberg N, Olbe L (1991) Lower esophageal sphincter characteristics and esophageal acid exposure following partial or 360° fundoplication: results of a prospective, randomised, clinical study. World J Surg 15: 115PubMedCrossRefGoogle Scholar
  66. [66]
    Lundell L, Abrahamsson H, Ruth M, Rydberg L, Lönroth H, Olbe L (1996) Long-term results of a prospective randomised comparison of total fundic wrap (Nissen-Rossetti) or semifundoplication (Toupét) for gastro-esophageal reflux. Br J Surg 83(6): 830–835PubMedGoogle Scholar
  67. [67]
    Rydberg L, Ruth M, Abrahamsson H, Lundell L (1999) Tailoring antireflux surgery: a randomised clinical trial. World J Surg 23(6): 612–618PubMedCrossRefGoogle Scholar
  68. [68]
    Walker SJ, Holt S, Sanderson CJ et al (1992) Comparison of Nissen total and Lind partial transabdominal fundoplication in the treatment of gastrooesophageal reflux. Br J Surg 79: 410–414PubMedGoogle Scholar
  69. [69]
    Csendes A, Burdiles P, Korn O et al (2000) Late results of a randomised clinical trial comparing total fund-oplication versus calibration of the cardia with posterior gastropexi. Br J Surg 87: 289–297PubMedCrossRefGoogle Scholar
  70. [70]
    Fibbe C, Layer P, Keller J et al (2001) Esophageal motility in reflux disease before and after fundoplication: a prospective, randomized, clinical and manometric study. Gastroenterology 212: 5–14CrossRefGoogle Scholar
  71. [71]
    Zorning C, Strate U, Fibbe C et al (2002) Nissen vs Toupet laparoscopic fundoplication. A prospective randomized study of 200 patients with and without preoperative esophageal motility disorders. Surg Endosc 16: 758–766CrossRefGoogle Scholar
  72. [72]
    Catarci M, Gentileschi P, Papi C et al (2004) Evidence-based appraisal of antireflux fundoplication. Ann Surg 239: 325–337PubMedCrossRefGoogle Scholar
  73. [73]
    Watson DI, Jamieson GG, Pike GK et al (1999) Prospective randomized double-blind trial between laparoscopic Nissen fundoplication and anterior partial fundoplication. Br J Surg 86: 123–130PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag/Wien 2006

Authors and Affiliations

  • L. Lundell
    • 1
  1. 1.Department of SurgeryKarolinska University HospitalHuddinge, StockholmSweden

Personalised recommendations