Gastroplasty and fundoplication for complex reflux problems. Long-term results.

Between 1964 and 1984, 430 patients with complex reflux problems were managed by a modified Collis gastroplasty and partial fundoplication. The indications for selecting the addition of gastroplasty were as follows: (1) obvious acquired shortening due to peptic esophagitis and stricture, and (2) subtler degrees of acquired shortening frequently encountered in cases that required reoperation and in patients with massive sliding hiatal hernia. The addition of gastroplasty in this second group obviates the risk of even minimal tension on the repair. Follow-up is complete in 382 patients (90%), and extends 1-20 years. Two hundred fifty patients have been followed up for 5 or more years and 101 patients for more than 10 years. Results were classified as follows: good: asymptomatic, or inconsequential symptoms requiring no therapy; fair: improved, but with symptoms and/or endoscopic findings requiring intermittent therapy; poor: unimproved or worse. Patients are divided into four categories, and the results are tabulated below (see Table 2). The best results are obtained in patients with acquired shortening due to esophagitis with and without stricture who have had no prior antireflux surgery and have no associated primary motor disorder. The proportion of unsatisfactory results is almost tripled (20% fair or poor) after reoperation after one or more failed antireflux procedures. When reflux esophagitis and stricture are associated with a primary motor disorder, only half of the patients have a good result sustained throughout long-term follow-up.