This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS

Long‐term effect of fundoplication on motility of the oesophagus and oesophagogastric junction. BJS 2004; 91: 1466-1472.

Published: 8th September 2004

Authors: R. C. H. Scheffer, M. Samsom, T. G. Frakking, A. J. P. M. Smout, H. G. Gooszen

Background

This study assessed the long‐term effect of Nissen fundoplication on oesophageal and oesophagogastric junction (OGJ) motility.

Method

Symptoms were scored and oesophageal manometry performed in 34 consecutive patients with chronic gastro‐oesophageal reflux disease, before, 3 months after and 2 years after surgery.

Results

Distal peristaltic amplitude increased from a median of 57 (95 per cent confidence interval (c.i.) 18 to 107) mmHg to 86 (95 per cent c.i. 54 to 208) mmHg (P < 0·001) at 3 months and 92 (45 to 210) mmHg (P < 0·001) at 2 years. In four patients the amplitude increased to more than 180 mmHg and three of these patients reported odynophagia. After surgery, a linear relationship was observed between the peristaltic amplitude and nadir OGJ relaxation pressure at 3 months (r_s = 0·68, P < 0·001) and 2 years (r_s = 0·64, P < 0·001). A significant correlation was also found between amplitude and both basal OGJ pressure and intrabolus pressure at 3 months (r_s = 0·58, P < 0·001 and r_s = 0·63, P < 0·001 respectively) and 2 years (r_s = 0·71, P < 0·001 and r_s = 0·49, P = 0·024). There was a relationship between peristaltic amplitude and the odynophagia score at 2 years (r_s = 0·60, P = 0·017).

Conclusion

Within 3 months of fundoplication the amplitude of oesophageal peristalsis increased substantially, leading to a nutcracker oesophagus and odynophagia in a subgroup of patients. These phenomena did not appear to progress with time. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

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