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Langenbeck's Archives of Surgery

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01-04-2005 | Original Article

Nissen or partial posterior fundoplication: which antireflux procedure has a lower rate of side effects?

Authors: Heinz Wykypiel, Michael Gadenstaetter, Alexander Klaus, Paul Klingler, Gerold J. Wetscher

Published in: Langenbeck's Archives of Surgery | Issue 2/2005

Abstract

Introduction

In patients with gastroesophageal reflux disease (GERD) it is still controversial as to which type of antireflux procedure—the Nissen or the partial posterior fundoplication—offers the lower rate of side effects in the long term.

Patients and methods

In this follow-up study the Nissen fundoplication was performed only in GERD patients with normal oesophageal peristalsis. The partial posterior fundoplication was preserved for patients with weak peristalsis. Only patients with effective postoperative control of GERD were included in the study. The study groups consisted of 77 patients who underwent the Nissen fundoplication and 132 patients who underwent partial posterior fundoplication. Clinical assessment of side effects was performed after a median of 52 months following surgery. Manometric assessment of the lower esophageal sphincter (LES) and of esophageal peristalsis was achieved 6 months after surgery.

Results

Side effects such as dysphagia, bloating, inability to belch and vomit, epigastric pain and early satiety were significantly more common after the Nissen fundoplication than after partial posterior fundoplication. Improvement of the antireflux barrier was equal in both groups; however, LES relaxation was incomplete following the Nissen fundoplication but normal after partial posterior fundoplication. Partial posterior fundoplication resulted in improved oesophageal peristalsis, whereas the Nissen fundoplication caused slight impairment of peristalsis.

Conclusions

Partial posterior fundoplication is a more physiological antireflux procedure than the Nissen fundoplication, and, therefore, this operation has now become our preferred technique for all GERD patients.

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Title: Nissen or partial posterior fundoplication: which antireflux procedure has a lower rate of side effects?
Authors: Heinz Wykypiel
Michael Gadenstaetter
Alexander Klaus
Paul Klingler
Gerold J. Wetscher
Publication date: 01-04-2005
Publisher: Springer-Verlag
Published in: Langenbeck's Archives of Surgery / Issue 2/2005
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-004-0537-0

At a glance: The STEP trials

Springer Medicine

Nissen or partial posterior fundoplication: which antireflux procedure has a lower rate of side effects?

Abstract

Introduction

Patients and methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Patients and methods

Results

Conclusions

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