Fate of Nissen fundoplication after 20 years. A clinical, endoscopical, and functional analysis
| Autor: | Markku Luostarinen, M Koskinen, A Uusitalo, J Laitinen, E Lehtinen, H Markkula, J Isolauri, Keyriläinen O |
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| Jazyk: | angličtina |
| Rok vydání: | 1993 |
| Předmět: |
Male
Time Factors medicine.medical_treatment Nissen fundoplication Gastroenterology Postoperative Complications Heartburn Recurrence Esophagitis Stage (cooking) medicine.diagnostic_test Incidence digestive oral and skin physiology Hydrogen-Ion Concentration Middle Aged Dysphagia Treatment Outcome Surgical Procedures Operative Gastroesophageal Reflux Female Esophagogastric Junction Esophagoscopy medicine.symptom Research Article Adult medicine.medical_specialty Manometry Regurgitation (circulation) digestive system Barrett Esophagus Internal medicine Preoperative Care medicine Humans Gastric Fundus Aged Postoperative Care Esophageal disease business.industry Reflux medicine.disease digestive system diseases Endoscopy Surgery Hernia Hiatal business Deglutition Disorders Follow-Up Studies |
| Popis: | Of 46 patients who had Nissen fundoplication for proved gastro-oesophageal reflux, 25 were available for follow up after a median of 20 years, 15 had died of unrelated causes, and six could not be traced. All 25 patients in the follow up study were personally interviewed: 21 consented to an endoscopy, 14 to 24 hour recording of oesophageal pH and manometry, and 15 to radionuclide transit test. Repeat fundoplication for recurrent reflux was performed in two cases during the study. Heartburn and regurgitation were significantly lessened (p < 0.005), but the incidence of dysphagia was slightly increased. Endoscopy showed six of 21 fundic wraps to be defective. Erosive oesophagitis was seen in two patients, and Barrett's oesophagus (histologically confirmed) in one of them and six other patients. Total reflux time was abnormal in four of 14 patients. No patient with an intact fundic wrap seen on endoscopy, only two of seven with Barrett's oesophagus, and one of four with abnormal reflux had oesophagitis. Fundoplication in itself did not affect oesophageal motility or transit, provided that the wrap was intact. It is concluded that Nissen fundoplication gave a reasonably good longterm effect in chronic reflux disease, with the stage of the fundic wrap as the main determinant of outcome. |
| Databáze: | OpenAIRE |
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