Long-term follow-up of the combined fundic patch fundoplication for treatment of longitudinal peptic strictures of the esophagus.

Optimum treatment of patients with esophageal strictures requires of the operating surgeon a wide repertoire of procedures suited to the individual circumstance. The Thal-Nissen procedure should be used in the patient with a longitudinal transmural stricture which cannot be easily dilated. When used in this setting, it widens the distal esophagus with a patch of well vascularized fundus and provides extremely effective protection against gastroesophageal reflux. Sixty-eight patients at the University of Florida underwent combined Thal-Nissen procedures for longitudinal peptic strictures. Operative mortality rate was 4%. The average length of follow-up was 68 months. Fifty-seven of 68 patients had an acceptable result (84%). Four per cent had an early recurrence of their stricture, while an additional 4% had late recurrence of their strictures, after an initially good response period of from two to 11 years. Four of the six patients with poor results had either achalasia, scleroderma, or diffuse esophageal spasm. The combined Thal-Nissen procedure represents the optimum therapy for the patient with an undilatable transmural stricture of the esophagus. When used in this setting, satisfactory results will be achieved in a large majority of patients with an extremely low operative mortality rate. Colonic or jejunal interposition should be reserved for those patients who either fail to respond to a combined Thal-Nissen procedure or who demonstrate sufficiently disordered peristalsis to render the esophagus an unsatisfactory conduit for the passage of food.