Nissen Fundoplication Without Crural Repair

Abstract

Since 1966, a total of 61 patients with reflux esophagitis with and without hiatal hernia have undergone fundoplication. Studies before operation revealed that 55 patients had roentgenographic evidence of reflux, 44 had endoscopic evidence of esophagitis, and 10 of 10 had low esophageal sphincter pressure. Good results were obtained in 90%, as evidenced by absence of dysphagia or phagodynia, esophagitis, and reflux. Thirty patients had crural repair added to fundoplication; 31 did not. The rate of recurrence of symptoms and the presence of reflux were equally divided between the two groups (three in each), and the cure rate was identical, suggesting that the principal reason for success of this repair is not creation of an intra-abdominal segment of the esophagus but is rather the valve mechanism fashioned at the esophagogastric junction.