BACKGROUND/AIMS: The authors compared the results of the Nissen fundoplication technique with the results of the Hill procedure, by using a 10-year history of patients with gastro-esophageal reflux disease. MATERIALS AND METHODS: Seventy two consecutive patients entered the study, 32 of whom underwent a 360 degrees fundoplication according to Nissen and 40 with a modified Hill operation. In the Nissen Group, intraoperative manometry (IOM) was carried out in all patients; in the Hill Group, the patients were randomized in two sub-groups (A and B), before operation; in 20 of them (group A), the procedure was randomly associated to IOM. RESULTS: The overall complications were low in both groups (15.6% in the Nissen Group and 5% in the Hill Group, p = 0.1), and there was no mortality rate. The clinical results were excellent or good in 28 patients (87.6%) of the Nissen Group and in 36 patients (90%) of the Hill Group (p = 0.5); in particular, an excellent outcome was observed in 16 patients (80%) with IOM (sub-group A), while 12 patients (60%) without it (sub-group B) showed similar results. The manometric studies carried out six months after surgical treatment showed a decrease of the lower esophageal sphincter pressures in all patients if compared to the pressure recorded intra-operatively. In comparison to the pre-operative values, both the lower esophageal sphincter length and its intra-abdominal portion were markedly increased in the Nissen Group and in the sub-group A of the Hill patients. CONCLUSIONS: These results support the conclusions that modified posterior gastropexy and 360 degrees fundoplication are effective, well tolerated, and can be properly used in the treatment of Gastro-esophageal reflux disease (GERD), since both techniques showed good clinical results. A favorable clinical outcome depends mostly on adequate lower esophageal sphincter length (LESL) and LESIA extension, which could be more efficiently achieved by the use of intraoperative manometry (IOM).
RCT Entities:
BACKGROUND/AIMS: The authors compared the results of the Nissen fundoplication technique with the results of the Hill procedure, by using a 10-year history of patients with gastro-esophageal reflux disease. MATERIALS AND METHODS: Seventy two consecutive patients entered the study, 32 of whom underwent a 360 degrees fundoplication according to Nissen and 40 with a modified Hill operation. In the Nissen Group, intraoperative manometry (IOM) was carried out in all patients; in the Hill Group, the patients were randomized in two sub-groups (A and B), before operation; in 20 of them (group A), the procedure was randomly associated to IOM. RESULTS: The overall complications were low in both groups (15.6% in the Nissen Group and 5% in the Hill Group, p = 0.1), and there was no mortality rate. The clinical results were excellent or good in 28 patients (87.6%) of the Nissen Group and in 36 patients (90%) of the Hill Group (p = 0.5); in particular, an excellent outcome was observed in 16 patients (80%) with IOM (sub-group A), while 12 patients (60%) without it (sub-group B) showed similar results. The manometric studies carried out six months after surgical treatment showed a decrease of the lower esophageal sphincter pressures in all patients if compared to the pressure recorded intra-operatively. In comparison to the pre-operative values, both the lower esophageal sphincter length and its intra-abdominal portion were markedly increased in the Nissen Group and in the sub-group A of the Hill patients. CONCLUSIONS: These results support the conclusions that modified posterior gastropexy and 360 degrees fundoplication are effective, well tolerated, and can be properly used in the treatment of Gastro-esophageal reflux disease (GERD), since both techniques showed good clinical results. A favorable clinical outcome depends mostly on adequate lower esophageal sphincter length (LESL) and LESIA extension, which could be more efficiently achieved by the use of intraoperative manometry (IOM).