Best GERD Results From Fixed Nondeformable Fundoplication

Joe Barber, Jr, PhD

December 14, 2011

December 14, 2011 — The complete fixed "nondeformable" fundoplication resulted in a lower long-term recurrence of gastroesophageal reflux disease than the Nissen and partial fundoplication techniques, according to the findings of a prospective clinical trial.

Moreno Mucio, MD, from GEA Hospital in Mexico City, Mexico, and colleagues published their findings in the January 2012 issue of Surgery.

Despite the demonstrated efficacy of antireflux surgery, the authors note that many issues remain. "There are several antireflux surgery complications, such as dysphagia, odynophagia, abdominal bloating, diarrhea, perforation, infection, and so on, and a significant percentage of patients may develop recurrent symptoms," the authors write.

In this study, the authors recruited 512 patients with gastroesophageal reflux disease who were randomly assigned to 1 of 4 treatment groups (partial, Nissen, fixed nondeformable, and medical treatment) and followed for 15 years. Among the 319 patients who completed the 15-year follow-up, the lowest incidence of gastroesophageal reflux disease was observed in the fixed nondeformable group (prevalence, 7.20%, 21.56%, 39.80%, and 47.05% for the fixed nondeformable, Nissen, partial, and medical treatment groups, respectively; P < .01).

The authors included patients who were at least 18 years old and had typical symptoms of gastroesophageal reflux disease and mucosal injury and lower esophageal sphincter resting pressure of less than 10 mm Hg. The authors excluded patients with associated comorbidity, those who underwent endoscopic or surgical obesity procedures, and those who underwent esophageal or stomach surgery.

The partial and fixed nondeformable groups exhibited greater lower esophageal sphincter length than the Nissen group after 15 years of follow-up (2.06 cm, 2.26 cm, and 0.74 cm for the partial, fixed nondeformable, and Nissen groups, respectively; P < .01). At the end of follow-up, lower esophageal sphincter pressure was significantly higher in the fixed nondeformable group than in the other groups (14.7, 9, 7.17, and 5.64 mm Hg for the fixed nondeformable, Nissen, partial, and medical treatment groups, respectively; P < .01). The fixed nondeformable group exhibited a significantly lower proportion of individuals with recurrent reflex (DeMeester score > 14.7) after 15 years of follow-up (13.6%, 37%, and 87% for the fixed nondeformable, Nissen, and partial groups, respectively; P < .01).

The authors suggest that their findings illustrate the safety and efficacy of the fixed nondeformable fundoplication technique. "The fixed 'nondeformable' fundoplication is an effective, safe, and feasible antireflux laparoscopic procedure," the authors write. "Permanent changes achieved at the [lower esophageal sphincter] are associated with long-lasting, restored quality of life."

The authors have disclosed no relevant financial relationships.

Surgery. 2011;151:84-93. Full text