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At least 19 recordsLinked to original sources
PubMed1990

Dysphagia following fundoplication: "slipped" fundoplication versus achalasia complicated by fundoplication.

Failure to obtain preoperative esophageal manometry in patients being considered for antireflux surgery can result in immediate persistent postoperative dysphagia due to a missed diagnosis of achalasia. We describe the clinical assessment and management of a case of delayed postoperative dysphagia due to a "slipped" fundoplication, which is contrasted with three patients with immediate postoperative dysphagia due to a missed diagnosis of achalasia. Surgical revision was required to correct the "slipped" fundoplication, and pneumatic dilatation was successfully used in two of three cases of achalasia complicated by fundoplication. Careful preoperative esophageal evaluation with manometry is essential to rule out the presence of a primary esophageal motor disorder.

Aged↗
PubMed1999

Laparoscopic fundoplication failures: patterns of failure and response to fundoplication revision.

OBJECTIVE: To determine rates and mechanisms of failure in 857 consecutive patients undergoing laparoscopic fundoplication for gastroesophageal reflux disease or paraesophageal hernia (1991-1998), and compare this population with 100 consecutive patients undergoing fundoplication revision (laparoscopic and open) at the authors' institution during the same period. SUMMARY BACKGROUND DATA: Gastroesophageal fundoplication performed through a laparotomy or thoracotomy has a failure rate of 9% to 30% and requires revision in most of the patients who have recurrent or new foregut symptoms. The frequency and patterns of failure of laparoscopic fundoplication have not been well studied. METHODS: All patients undergoing fundoplication revision were included in this study. Symptom severity was scored before and after surgery by patients on a 4-point scale. Evaluation of patients included esophagogastroscopy, barium swallow, esophageal motility, 24-hour ambulatory pH, and gastric emptying studies. Statistical analysis was performed with multiple chi-square analyses, Fisher exact test, and analysis of variance. RESULTS: Laparoscopic fundoplication was performed in 758 patients for gastroesophageal reflux disease and in 99 for paraesophageal hernia. Median follow-up was 2.5 years. Thirty-one patients (3.5%) have undergone revision for fundoplication failure. The mechanism of failure was transdiaphragmatic herniation of the fundoplication in 26 patients (84%). In 40 patients referred from other institutions, after laparoscopic fundoplication, only 10 (25%) had transdiaphragmatic migration (p < 0.01); a slipped or misplaced fundoplication occurred in 13 patients (32%), and a twisted fundoplication in 12 patients (30%). The failure mechanisms of open fundoplication (29 patients) followed patterns previously described. Fundoplication revision procedures were initiated laparoscopically in 65 patients, with six conversions (8%). The morbidity rate was 4% in laparoscopic procedures and 9% in open ones. There was one death, from aspiration and adult respiratory distress syndrome after open fundoplication. A year or more after revision operation, heartburn, chest pain, and dysphagia were rare or absent in 88%, 78%, and 91%, respectively, after laparoscopic revision, and were rare or absent in 91%, 83%, and 70%, respectively, after open revision, but 11 patients ultimately required additional operations for continued or recurrent symptoms, 3 after open revision (17%), and 8 after laparoscopic fundoplication (11%). CONCLUSIONS: Laparoscopic fundoplication failure is infrequent in experienced hands; the rate may be further reduced by extensive esophageal mobilization, secure diaphragmatic closure, esophageal lengthening (applied selectively), and avoidance of events leading to increased intraabdominal pressure. When revision is required, laparoscopic access may be used successfully by the laparoscopically experienced esophageal surgeon.

Fundoplication↗
PubMed2000

Heartburn is more likely to recur after Toupet fundoplication than Nissen fundoplication.

Toupet (270 degrees) fundoplication is commonly recommended for patients with gastroesophageal reflux (GER) and esophageal dysmotility. However, Toupet fundoplication may be less effective at protecting against reflux than Nissen (360 degrees) fundoplication. We therefore compared the effectiveness and durability of both types of fundoplication as a function of preoperative esophageal motility. From January 1992 through January 1998, 669 patients with GER underwent laparoscopic fundoplication (78 Toupet, 591 Nissen). Patients scored heartburn, regurgitation, and dysphagia preoperatively, and at 6 weeks and 1 year postoperatively, using a 0 ("none") to 3 ("severe") scale. We compared symptom scores (Wilcoxon rank sum test) and redo fundoplication rates (Fisher exact test) in Toupet and Nissen patients. We also performed subgroup analyses on 81 patients with impaired esophageal motility (mean peristaltic amplitude, <30 mm Hg or peristalsis <70% of wet swallows) and 588 patients with normal esophageal motility. Toupet and Nissen patients reported similar preoperative heartburn, regurgitation, and dysphagia. At 6 weeks after operation, heartburn and regurgitation were similarly improved in both groups, but dysphagia was more prevalent among Nissen patients. After 1 year, heartburn and regurgitation were re-emerging in Toupet patients, and dysphagia was again similar between groups. Patients with impaired motility who have Nissen fundoplication are no more likely to suffer persistent dysphagia than their counterparts who have Toupet fundoplication. In addition, patients with normal motility are more likely to develop symptom recurrence after Toupet fundoplication than Nissen fundoplication, with no distinction in dysphagia rates. We conclude that since Toupet patients suffer more heartburn recurrence than Nissen patients, with similar dysphagia, selective use of Toupet fundoplication requires further study.

Deglutition Disorders↗
PubMed1994

Laparoscopic repair of gastroesophageal reflux disease. Toupet partial fundoplication versus Nissen fundoplication.

This report describes our preliminary experience with two surgical laparoscopic fundoplication procedures, the Nissen technique and the Toupet operation, in which the fundal wrap is reduced from 360 degrees to 180-200 degrees. Fourteen patients with symptomatic gastroesophageal reflux disease who were refractory to pharmacologic and medical therapy underwent a laparoscopic Nissen fundoplication; in an additional 14 patients, we performed a laparoscopic Toupet partial fundoplication. Our laparoscopic approach to the two procedures does not differ significantly from the traditional open methods and the effectiveness of the laparoscopic fundoplication procedures appears similar to that of the same conventional techniques. Oral feedings can be resumed on the first postoperative day and patients typically are discharged on the second day after surgery. Operative time for performing the Toupet procedure averaged just approximately 1.6 h and was shorter than that for the Nissen fundoplication, due to the use of a stapler to secure the fundal wrap. Confirming earlier observations, the laparoscopic Toupet 180-200 degrees fundoplication was associated with a lower incidence of postoperative digestive complications, such as dysphagia, than was the laparoscopic Nissen operation. The laparoscopic fundoplication approach offers the advantages of clear visualization, adequate dissection and precise repair, along with the benefits associated with endoscopic surgery: diminished postoperative pain and discomfort, reduced hospitalization, and quicker return to normal activities. Our experience indicates that the Toupet fundoplication may be preferable to the Nissen technique for many patients requiring surgical treatment of their reflux disease.

Adult↗
PubMed2000

Efficacy of a 90 degree anterior fundoplication vs a total fundoplication in an experimental model.

BACKGROUND: The surgical treatment of gastroesophageal reflux disease (GERD) has improved greatly, so that excellent long-term control of symptoms can now be achieved. At present, the gold standard for treatment is the Nissen fundoplication. However, this procedure produces side effects in some patients, including persistent dysphagia, epigastric bloating, and excessive flatulence. As a result, some surgeons who have recommended the use of a partial fundoplication to lessen the occurrence of these side effects. The aim of this study was to determine the efficacy of a laparoscopically constructed 90 degree anterior fundoplication and to compare this method with the Nissen fundoplication. METHODS: Twelve domestic white pigs underwent initial esophageal myotomy to ensure an incompetent lower esophageal sphincter. These animals were then randomized to undergo either a total fundoplication or a 90 degree wrap. All procedures were completed laparoscopically. Resting lower esophageal sphincter pressures were measured immediately and at 2 weeks postoperatively with a water-perfused esophageal manometry catheter incorporating a Dent sleeve. The efficacy of the antireflux barrier was determined at 2 weeks after surgery by fundoplication yield studies. RESULTS: Both the total fundoplication and the 90 degree wrap produced an increase in resting lower esophageal sphincter pressure and restored adequate competence to the gastroesophageal junction in the early postoperative period. CONCLUSION: A laparoscopically completed 90 degree anterior fundoplication restores lower esophageal sphincter competence in the early postoperative period. Clinical studies examining the long-term results and significant side effects of this procedure are required to establish the place for this procedure in the antireflux surgery armamentarium.

Animals↗
PubMed1999

Prospective randomized double-blind trial between laparoscopic Nissen fundoplication and anterior partial fundoplication.

BACKGROUND: In the operative management of gastro-oesophageal reflux, a balance must be achieved between adequate control of reflux and excessive dysphagia. The ideal technique is not known. A randomized study was performed to determine whether laparoscopic anterior fundoplication is associated with a lower incidence of postoperative dysphagia than laparoscopic Nissen fundoplication, while achieving equivalent control of reflux. METHODS: Patients presenting for laparoscopic antireflux surgery were randomized to undergo either a Nissen fundoplication (n = 53) or an anterior 180 degrees hemifundoplication (n = 54). Patients were blinded to which procedure had been performed, and follow-up was obtained by a blinded independent investigator. Standardized clinical grading systems were used to assess dysphagia, heartburn and patient satisfaction 1, 3 and 6 months after operation. Objective measurement of lower oesophageal sphincter pressure, oesophageal emptying time, distal oesophageal acid exposure and endoscopic healing of oesophagitis was also performed. RESULTS: Operating time was similar for the two procedures (58 min for the Nissen procedure versus 60 min for anterior fundoplication). Resting and residual lower oesophageal sphincter pressures were lower following anterior fundoplication (29 versus 18 mmHg, and 13 versus 6 mmHg), and oesophageal emptying times were faster (92 versus 116 s). Acid exposure times and ability to heal oesophagitis were similar. At 3 months' follow-up clinical outcomes were similar for the two procedures. At 6 months, however, patients who had undergone anterior fundoplication experienced significantly less dysphagia for solid food and were more likely to be satisfied with the clinical outcome. CONCLUSION: Laparoscopic anterior fundoplication achieved equivalent control of reflux, more physiological postoperative manometry parameters, and an improved clinical outcome at 6 months. Continued follow-up remains necessary to confirm the long-term efficacy of the partial fundoplication procedure.

Double-Blind Method↗
PubMed1997

Modified Nissen fundoplication for reduction of fundoplication failure.

Failure of the Nissen fundoplication can be secondary to disruption of the wrap or slippage of the stomach upward within the wrap. A modification of the Nissen fundoplication was devised and implemented between 1982 and 1995 to eliminate these complications. This report describes the modification and the results. Commonly, the Nissen fundoplication uses a single anterior row of sutures securing the wrapped stomach to the esophagus. This modification reinforces the wrap with two additional rows of suture, one right lateral and one left lateral, each further anchoring the wrapped stomach to the esophagus. This retrospective analysis compares the Nissen and modified Nissen fundoplications performed at our institution. Fundoplication operations were considered a failure if they required a reoperation secondary to wrap disruption or stomach slippage. Data were analyzed using the chi 2 method. A total of 948 fundoplication procedures were performed; 326 Nissen and 622 modified Nissen. Follow-up ranged from 0.5 to 13 years (mean, 6 years). Thirteen wrap disruptions and six stomach slippages occurred in the Nissen group (5.8%); 10 wrap failures and no stomach slippages occurred in the modified Nissen group (1.6%), P < .05. The authors conclude that this modification of the Nissen fundoplication significantly reduces wrap disruptions and stomach slippages.

Chi-Square Distribution↗
PubMed2002

Effective Nissen fundoplication length and bougie diameter size in young children undergoing laparoscopic Nissen fundoplication.

BACKGROUND/PURPOSE: Laparoscopic Nissen fundoplication (LNF) is utilized in the management of symptomatic gastroesophageal reflux disease (GERD) in children. An effective length of fundoplication and bougie size has never been established in infants and children requiring LNF for GERD. To determine this effective fundoplication length and appropriate bougie size, we analyzed all patients less than 15 kg undergoing LNF for GERD over a 2-year period. METHODS: Data recovered retrospectively included age, weight, gender, need for gastrostomy, length of postoperative hospitalization, operating time, bougie size, and fundoplication length. RESULTS: One hundred patients weighed less than 15 kg (mean, 7.23 kg). Mean operating time was 95 minutes (range, 31 minutes to 159 minutes). Gastrostomies were placed in 32 patients. Postoperative hospitalization averaged 1.8 days for elective LNF. Fundoplication length was measured in each patient and averaged 2.06 cm. Bougie size varied from 22F to 42F, and the size utilized was based on the patient's weight. There were no instances of dysphagia or the need for esophageal dilatation postoperatively. Two patients have been seen for recurrent symptoms. One patient has required a second LNF, and the other has a normal upper gastrointestinal study and pH study. CONCLUSION: This study of LNF in small children has shown that resolution of GERD symptoms in most patients can be accomplished with an average fundoplication length of approximately 2 cm and a graduated bougie size relative to the patient's weight.

Child, Preschool↗
PubMed2001

Post-fundoplication symptoms: the role for endoscopic assessment of fundoplication integrity.

BACKGROUND: Fundoplication is now almost exclusively a laparoscopic procedure. The aim of this study was the comparison of the diagnostic usefulness of endoscopy and barium esophagram in the detection of fundoplication abnormalities. METHODS: Twenty-two patients presented with symptoms post-laparoscopic (Nissen) fundoplication that included dysphagia (14 patients), heartburn (5 patients), dyspepsia (2 patients), and chest pain (1 patient). Barium esophagram and upper endoscopy were performed in all patients and the results were compared. Key features included presence of esophagitis, resistance to endoscope passage, location of the wrap relative to the diaphragmatic hiatus, location of squamocolumnar junction greater than 1 cm proximal to the wrap zone, and the appearance of the wrap (intact, loose, disrupted, or tight). RESULTS: The key features explained symptoms in 20 of 22 patients. Endoscopy detected twice as many key features as radiography. Disruption of the wrap or excessive proximal location of the squamocolumnar junction proximal to the wrap zone were the most incriminating endoscopic findings. Resistance to endoscope passage was rarely encountered and the esophagram was more accurate in detecting an overly tight wrap. CONCLUSIONS: Endoscopic evaluation is more accurate than barium esophagram in detecting post-fundoplication abnormalities. The appearance of the fundoplication wrap and an abnormal proximal location of the squamocolumnar junction appear to be major endoscopic clues in diagnosis of post-fundoplication problems.

Barium Sulfate↗
PubMed2002

A further modification of fundoplication. 90 degrees anterior fundoplication.

BACKGROUND: Laparoscopic Nissen fundoplication is the most widely applied procedure for the surgical treatment of gastroesophageal reflux. However, it can be followed by adverse outcomes, including dysphagia and "wind-related" problems. To reduce the likelihood of side effects, we have progressively modified this procedure to an anterior 90 degrees partial fundoplication. METHODS: The procedure entails posterior hiatal repair, posterior esophagopexy, accentuation of the angle of His, and construction of a 90 degrees anterior partial fundoplication. Clinical follow-up was performed prospectively using a standardized questionnaire. RESULTS: From February 1999 to June 2001, 83 patients underwent 90 degrees anterior fundoplication for gastroesophageal reflux disease. In 45 the procedure was chosen because of specific patient or surgeon preference, and in 38 it was performed within the context of an ongoing randomized trial. Operating time ranged from 20 to 140 minutes (median, 52 min), and all but one of the procedures were completed laparoscopically. One patient experienced a major postoperative complication--small bowel injury from Veress needle. Follow-up extends up to 2 years (median, 1 year). Two patients have undergone further surgery, both for recurrent reflux. Control of reflux has been acceptable, with a reduction in heartburn symptom scores and high overall satisfaction. Postoperative dysphagia measured using a visual analog scale was less following surgery compared with preoperative scores. Eighty-two percent of patients could belch normally 3 and 12 months after surgery. CONCLUSIONS: Ninety-degree anterior fundoplication achieves good control of reflux and a low incidence of side effects. To further evaluate its potential, we are currently undertaking a prospective randomized trial.

Adult↗
PubMed1997

Laparoscopic partial fundoplication vs laparoscopic Nissen-Rosetti fundoplication. Short-term results of 231 cases.

BACKGROUND: Since 1992, all patients at our institution who have met standard accepted criteria for surgical intervention for complicated gastroesophageal reflux disease have been entered into a prospective sequential clinical study to evaluate outcomes of the laparoscopic approach to the Nissen-Rosetti procedure and a modified Toupet procedure. METHODS: A standardized workup with upper GI series, esophagography, and endoscopy was used in all patients. Manometry, pH testing, and other special tests were used selectively. A measuring technique was used to determine wrap size without the use of dilators. The short gastric vessels were left intact in all patients. A cosurgeon approach was used, with technical factors described herein. RESULTS: Some 226 of 231 cases were completed laparoscopically (98%)-125 patients in the Nissen-Rosetti group and 101 in the partial fundoplication group. There were no clinical failures in either group. The partial fundoplication group performed better than the Nissen-Rosetti group in all categories of comparison. Return to normal eating habits was much earlier in the partial wrap group (p < 0.0001). Postop distal esophageal sphincter pressures in the two groups were equal at 15 mmHg. Eight patients suffered significant dysphagia requiring endoscopy and dilatation, all in the Nissen-Rosetti group (p < 0.01). Minor complications occurred in 12% of the total group. There was a total surgical revision rate of 3%. There were no gastric or esophageal perforations. Average operative time was 30 min. Average hospital stay was 1.4 days. Hospital charges for the laparoscopic approach averaged $6,000 dollars compared to $12,000 for the open approach. CONCLUSION: Laparoscopic partial fundoplication is as effective as laparoscopic Nissen-Rosetti fundoplication, with a higher satisfaction rate and fewer side effects. Measuring for wrap and hiatus size eliminates the need for and risk of using stiff dilators. By utilizing cosurgeons and currently available technology, cost, operative time, hospital time, and complications can be reduced to a finite minimum.

Adolescent↗
PubMed1983

Post-fundoplication symptoms. Do they restrict the success of Nissen fundoplication?

The post-fundoplication symptoms were assessed in 226 patients who had symptomatical improvement of gastroesophageal reflux after Nissen fundoplication. Follow-up range was from 3 to 12 years (average 5,6 years). Of these patients, 24% were totally asymptomatic. All had transient postoperative dysphagia which improved within an average of 3-5 months. Forty four per cent had changes in habits of swallowing; 38% had increased abdominal meteorism; 31% were unable to vomit and 19% unable to belch; 12% had pain in the upper left abdominal quadrant; and 10% had dyspepsia. These symptoms were uncomfortable in 26% and disturbing in 10%. Diverse causes can be responsible for these symptoms; mechanical (narrowing of the cardia, postoperative adherences), functional (motor troubles, denervation), and depending of the patients (alimentary habits). The high frequency of post-fundoplication symptoms restrict clearly the success of Nissen fundoplication.

Adult↗
PubMed2001

[Outcome after laparoscopic antireflux surgery: fundoplication and re-fundoplication in the elderly].

PURPOSE: Treatment of gastroesophageal reflux disease (GERD) in the elderly follows the same principles as for any adult patient. The indication for laparoscopic antireflux surgery (LARS) often depends on the age of the patient. The aim of this prospective study was to evaluate the surgical outcome including quality of life after LARS and laparoscopic "redo-surgery" in patients older than 65 years. METHODS: Since 1993, 75 patients with a mean age of 71 years have been treated with laparoscopic "floppy" Nissen (n = 53) or Toupet (n = 22) fundoplication. Thirteen patients underwent laparoscopic redo-surgery after failed LARS. Quality of life (GIQLI) was assessed before surgery and 3 months and 1 year after surgery, with 24-h pH monitoring and esophageal manometry being performed. RESULTS: Intraoperative complications occurred in two patients with primary LARS, successfully managed laparoscopically. The conversion and mortality rate was 0%. In two patients postoperative complications occurred. Three months and 1 year after surgery 24-h pH monitoring and esophageal manometry showed normal values in all patients. GIQLI increased significantly after surgery and is comparable to that of healthy individuals. One patient suffered from severe dysphagia and required dilatation. In 13 patients who underwent laparoscopic refundoplication, redo procedure was completed laparoscopically in 12 patients. In one patient conversion was necessary because of severe bleeding from the spleen. Data of esophageal manometry and 24-h pH monitoring showed normal values in all patients after redo-surgery. Three months and 1 year after laparoscopic reoperation the general score of GIQLI increased significantly (p < 0.01) and reached a level equivalent to that of comparable healthy individuals. CONCLUSION: Laparoscopic fundoplication and refundoplication in the elderly patient is a safe and effective treatment in GERD and improves quality of life significantly. Age should not be longer a contraindication to LARS.

Age Factors↗
PubMed2000

Laparoscopic Nissen fundoplication: a technique for the easy and precise manufacture of a true fundoplication.

Passing the stomach behind the esophagus during laparoscopic Nissen fundoplication is a common source of frustration for the laparoscopic surgeon. It often leads to an incorrect formation of the fundoplication, resulting in a wrapping or twisting of the fundus around the distal esophagus. The correct technique should result in the distal esophagus being enveloped inside the fundus without distorting the orientation of the greater curve. We have developed an easy, precise, and reproducible technique to perform this maneuver. The steps for performance of this maneuver are described.

Fundoplication↗
PubMed2000

Severe dysphagia after laparoscopic fundoplication: usefulness of barium meal examination to identify causes other than tight fundoplication--a prospective study.

Background. The aim of this study was to determine the results of a barium meal examination after laparoscopic wrap in symptomatic patients (SPs) with no upper endoscopic anomalies and no increase in inferior esophageal sphincter pressure (SPs). Radiologic results were compared with results from patients with no symptoms (ASPs) and were compared with the surgical findings in patients who underwent reoperation. Methods. Twenty SPs were included 27 +/- 6 months after a total wrap (n = 13 Nissen procedures) or a posterior wrap (n = 7 Toupet procedures) performed in several hospitals in Haute Normandie. All patients had severe symptomatic dysphagia with epigastric pain (n = 18 patients) and/or marked weight loss (n = 16 patients). Control subjects were 31 consecutive ASPs within our center who were prospectively included 4 +/- 1 months after a Nissen (n = 6 patients) or a Toupet (n = 25 patients) procedure. A barium meal examination was performed in all patients and interpreted by 3 independent observers who knew that the patients had undergone a wrap but who did not know whether the patients had symptoms. Fifteen of the 20 SPs underwent a second operation. Results. Barium meal examination was more often abnormal in SPs than in ASPs (17/20 vs 4/31 patients; P <.001), whichever the type of wrap. Two abnormal radiologic results were observed in both groups: an esophageal barium level and an esogastric plication. Only a high barium level in the esophagus was more frequently observed in SPs than in ASPs (P <.05). Three radiologic results were specifically observed in SPs: a long cardial narrowing beginning above the wrap, a mediogastric plication, and a gastric volvulus. A comparison of radiologic anomalies and surgical findings showed that (1) a radiologic long cardial narrowing was explained by fibrotic stenosis of the muscular esophageal hiatus (n = 6 patients), (2) a mediogastric plication (n = 4 patients) was due to gastric volvulus (n = 3 patient) or to gastric wrap (n = 1 patient), and (3) results of volvulus (n = 5 patients) indicated a gastric volvulus. Additional surgical procedures resulted in the disappearance of symptoms in 13 of 15 patients. Conclusions. After laparoscopic fundoplication when upper endoscopy and esophageal manometry are normal, results of a barium meal examination can explain the cause of dysphagia in almost all patients. Three radiologic results were specific for SPs and indicated major morphologic disturbances that could not be treated by endoscopic dilation but that could be treated by additional surgical procedures.

Administration, Oral↗
PubMed1997

A randomized, prospective comparison of the Nissen fundoplication versus the Toupet fundoplication for gastroesophageal reflux disease.

OBJECTIVE: A prospective, randomized trial was performed to determine which of two antireflux procedures, a complete wrap (Nissen) or a 200N wrap (Toupet), was more effective with fewer sequelae. SUMMARY BACKGROUND DATA: Laparoscopic procedures for gastroesophageal reflux disease appear to be as effective as those done by open laparotomy. The Nissen fundoplication is used most frequently, but postoperative bloating, inability to belch, and dysphagia occur. The partial wrap has been said to be as effective with less unfavorable postoperative symptoms. METHODS: Patients with reflux esophagitis were approached laparoscopically using a six-port technique. After division of the short gastric vessels and dissection of the terminal esophagus and fundus of the stomach to allow performance of either procedure, patients randomly were assigned one of the procedures by a card drawn in the operating room. RESULTS: Forty patients underwent operation, but 1 was excluded when an open procedure became necessary. Twenty-three patients received a complete wrap and 16 received a partial wrap. The average operating time was 155 minutes for the Nissen procedures and 162 minutes for the Toupet procedures. The postoperative stay averaged 2.7 days for the Nissen procedures and 2.5 days for the Toupet procedures. There were no deaths. Including the patient converted to an open procedure, three patients had operative complications. At follow-up, Visick scores after the complete wraps were I-13, II-8, III-2 and after the partial wrap were I-12 and II-3. Two patients indicated they would not have the operation again. CONCLUSIONS: A partial or a complete wrap after division of the short gastric vessel offers effective therapy for reflux esophagitis with > 90% patient satisfaction. The authors' study shows no clear advantage of one wrap (partial or complete) over the other.

Female↗