Total fundoplication is superior to partial fundoplication even when esophageal peristalsis is weak

Marco G. Patti, Thomas Robinson, Carlos A Galvani, Maria V. Gorodner, Piero M. Fisichella, Lawrence W. Way, John G. Hunter, Marco G. Patti

Research output: Contribution to journalArticle

104 Citations (Scopus)

Abstract

Background About a decade ago, partial (240 degrees) fundoplication became popular for treating gastroesophageal reflux disease in cases where the patient's primary esophageal peristalsis was weak. A total (360 degrees) fundoplication was reserved for patients with normal peristalsis (tailored approach). The theory was that partial fundoplication was an adequate antireflux measure, and by posing less resistance for the weak esophageal peristalsis to overcome, it would give rise to less dysphagia. Short-term results seemed to confirm these ideas. Study design This study reports the longterm followup of patients in whom a tailored approach (type of wrap chosen to match esophageal peristalsis) was used, and the results of a nonselective approach, using a total fundoplication regardless of the amplitude of esophageal peristalsis. We analyzed clinical and laboratory findings in 357 patients who had an operation for gastroesophageal reflux disease between October 1992 and November 2002. Group 1 was composed of 235 patients in whom a tailored approach was used between October 1992 and December 1999 (141 patients, partial fundoplication and 94 patients, total fundoplication). Group 2 contained 122 patients in whom a nonselective approach was used (total fundoplication regardless of quality of peristalsis). Results In group 1, heartburn from reflux (ie, pH monitoring test was abnormal) recurred in 19% of patients after partial fundoplication and in 4% after total fundoplication. In group 2, heartburn recurred in 4% of patients after total fundoplication. The incidence of postoperative dysphagia was similar in the two groups. Conclusions These data show that laparoscopic partial fundoplication was less effective than total fundoplication in curing gastroesophageal reflux disease, and compared with a partial (240 degrees) fundoplication, a total (360 degrees) fundoplication was not followed by more dysphagia, even when esophageal peristalsis was weak.

Original languageEnglish (US)
Pages (from-to)863-870
Number of pages8
JournalJournal of the American College of Surgeons
Volume198
Issue number6
DOIs
StatePublished - Jun 2004
Externally publishedYes

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Peristalsis
Fundoplication
Deglutition Disorders
Gastroesophageal Reflux
Heartburn

ASJC Scopus subject areas

  • Surgery

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Total fundoplication is superior to partial fundoplication even when esophageal peristalsis is weak. / Patti, Marco G.; Robinson, Thomas; Galvani, Carlos A; Gorodner, Maria V.; Fisichella, Piero M.; Way, Lawrence W.; Hunter, John G.; Patti, Marco G.

In: Journal of the American College of Surgeons, Vol. 198, No. 6, 06.2004, p. 863-870.

Research output: Contribution to journalArticle

Patti, Marco G. ; Robinson, Thomas ; Galvani, Carlos A ; Gorodner, Maria V. ; Fisichella, Piero M. ; Way, Lawrence W. ; Hunter, John G. ; Patti, Marco G. / Total fundoplication is superior to partial fundoplication even when esophageal peristalsis is weak. In: Journal of the American College of Surgeons. 2004 ; Vol. 198, No. 6. pp. 863-870.
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title = "Total fundoplication is superior to partial fundoplication even when esophageal peristalsis is weak",
abstract = "Background About a decade ago, partial (240 degrees) fundoplication became popular for treating gastroesophageal reflux disease in cases where the patient's primary esophageal peristalsis was weak. A total (360 degrees) fundoplication was reserved for patients with normal peristalsis (tailored approach). The theory was that partial fundoplication was an adequate antireflux measure, and by posing less resistance for the weak esophageal peristalsis to overcome, it would give rise to less dysphagia. Short-term results seemed to confirm these ideas. Study design This study reports the longterm followup of patients in whom a tailored approach (type of wrap chosen to match esophageal peristalsis) was used, and the results of a nonselective approach, using a total fundoplication regardless of the amplitude of esophageal peristalsis. We analyzed clinical and laboratory findings in 357 patients who had an operation for gastroesophageal reflux disease between October 1992 and November 2002. Group 1 was composed of 235 patients in whom a tailored approach was used between October 1992 and December 1999 (141 patients, partial fundoplication and 94 patients, total fundoplication). Group 2 contained 122 patients in whom a nonselective approach was used (total fundoplication regardless of quality of peristalsis). Results In group 1, heartburn from reflux (ie, pH monitoring test was abnormal) recurred in 19{\%} of patients after partial fundoplication and in 4{\%} after total fundoplication. In group 2, heartburn recurred in 4{\%} of patients after total fundoplication. The incidence of postoperative dysphagia was similar in the two groups. Conclusions These data show that laparoscopic partial fundoplication was less effective than total fundoplication in curing gastroesophageal reflux disease, and compared with a partial (240 degrees) fundoplication, a total (360 degrees) fundoplication was not followed by more dysphagia, even when esophageal peristalsis was weak.",
author = "Patti, {Marco G.} and Thomas Robinson and Galvani, {Carlos A} and Gorodner, {Maria V.} and Fisichella, {Piero M.} and Way, {Lawrence W.} and Hunter, {John G.} and Patti, {Marco G.}",
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T1 - Total fundoplication is superior to partial fundoplication even when esophageal peristalsis is weak

AU - Patti, Marco G.

AU - Robinson, Thomas

AU - Galvani, Carlos A

AU - Gorodner, Maria V.

AU - Fisichella, Piero M.

AU - Way, Lawrence W.

AU - Hunter, John G.

AU - Patti, Marco G.

PY - 2004/6

Y1 - 2004/6

N2 - Background About a decade ago, partial (240 degrees) fundoplication became popular for treating gastroesophageal reflux disease in cases where the patient's primary esophageal peristalsis was weak. A total (360 degrees) fundoplication was reserved for patients with normal peristalsis (tailored approach). The theory was that partial fundoplication was an adequate antireflux measure, and by posing less resistance for the weak esophageal peristalsis to overcome, it would give rise to less dysphagia. Short-term results seemed to confirm these ideas. Study design This study reports the longterm followup of patients in whom a tailored approach (type of wrap chosen to match esophageal peristalsis) was used, and the results of a nonselective approach, using a total fundoplication regardless of the amplitude of esophageal peristalsis. We analyzed clinical and laboratory findings in 357 patients who had an operation for gastroesophageal reflux disease between October 1992 and November 2002. Group 1 was composed of 235 patients in whom a tailored approach was used between October 1992 and December 1999 (141 patients, partial fundoplication and 94 patients, total fundoplication). Group 2 contained 122 patients in whom a nonselective approach was used (total fundoplication regardless of quality of peristalsis). Results In group 1, heartburn from reflux (ie, pH monitoring test was abnormal) recurred in 19% of patients after partial fundoplication and in 4% after total fundoplication. In group 2, heartburn recurred in 4% of patients after total fundoplication. The incidence of postoperative dysphagia was similar in the two groups. Conclusions These data show that laparoscopic partial fundoplication was less effective than total fundoplication in curing gastroesophageal reflux disease, and compared with a partial (240 degrees) fundoplication, a total (360 degrees) fundoplication was not followed by more dysphagia, even when esophageal peristalsis was weak.

AB - Background About a decade ago, partial (240 degrees) fundoplication became popular for treating gastroesophageal reflux disease in cases where the patient's primary esophageal peristalsis was weak. A total (360 degrees) fundoplication was reserved for patients with normal peristalsis (tailored approach). The theory was that partial fundoplication was an adequate antireflux measure, and by posing less resistance for the weak esophageal peristalsis to overcome, it would give rise to less dysphagia. Short-term results seemed to confirm these ideas. Study design This study reports the longterm followup of patients in whom a tailored approach (type of wrap chosen to match esophageal peristalsis) was used, and the results of a nonselective approach, using a total fundoplication regardless of the amplitude of esophageal peristalsis. We analyzed clinical and laboratory findings in 357 patients who had an operation for gastroesophageal reflux disease between October 1992 and November 2002. Group 1 was composed of 235 patients in whom a tailored approach was used between October 1992 and December 1999 (141 patients, partial fundoplication and 94 patients, total fundoplication). Group 2 contained 122 patients in whom a nonselective approach was used (total fundoplication regardless of quality of peristalsis). Results In group 1, heartburn from reflux (ie, pH monitoring test was abnormal) recurred in 19% of patients after partial fundoplication and in 4% after total fundoplication. In group 2, heartburn recurred in 4% of patients after total fundoplication. The incidence of postoperative dysphagia was similar in the two groups. Conclusions These data show that laparoscopic partial fundoplication was less effective than total fundoplication in curing gastroesophageal reflux disease, and compared with a partial (240 degrees) fundoplication, a total (360 degrees) fundoplication was not followed by more dysphagia, even when esophageal peristalsis was weak.

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