Prospective evaluation of the effects of Nissen fundoplication on gastroesophageal reflux.

In 27 patients with uncontrollable gastroesophageal reflux, a modified Nissen fundoplication was performed. To investigate the long term effects of this procedure, 24-hour ambulatory esophageal pH monitoring was performed on three occasions: preoperatively, four weeks and two years postoperatively. Preoperative and postoperative symptoms were assessed. In 13 patients, fundoplication reduced reflux to zero (percentage of time pH less than 4, zero per cent), and in another 11 patients, reflux was reduced to a very low level (percentage of time pH less than 4, 0.75 +/- 0.21 per cent). The procedure failed in three patients, in whom both reflux symptoms and a pathologic pH profile persisted. No significant differences could be demonstrated between reflux variables in the early and late postoperative pH studies. Postoperatively, ten patients complained of heartburn or regurgitation, but pathologic reflux could only be demonstrated in three of these, and in two, there was macroscopic evidence of esophagitis. It is concluded that Nissen fundoplication abolishes or nearly abolishes gastroesophageal reflux in the majority of patients. Also, as in patients not operated upon, symptoms are unreliable indicators of the severity of gastroesophageal reflux after an antireflux procedure.