Late subjective and objective evaluations of antireflux surgery in patients with reflux esophagitis: analysis of 215 patients

Abstract

The results of late subjective and objective evaluations of antireflux surgery in 215 patients with reflux esophagitis who were included in a prospective, controlled study are reported. A special protocol--including analysis of reflux symptoms, radiology, endoscopy, esophageal manometry, and standard acid reflux test--was designed. The surgical technique used was as follows: (1) highly selective vagotomy, (2) closure of the hiatus, (3) calibration of the cardia, (4) posterior gastropexy, and (5) fixation of the gastric fundus to the diaphragm. The operative mortality rate was 0.4%, and postoperative complications occurred in 5% of the patients. Only 5% of the patients were lost from the late follow-up. A total of 150 patients with more than 5 years since operation were completely evaluated. Reflux symptoms greatly decreased after surgery. Radiologic studies were normal in 93% of the patients, and endoscopy showed a long-standing healing of macroscopic esophagitis in 83% of the cases. Manometric features were analyzed in 159 patients before and in 115 patients 1 year after surgery. A significant increase in lower esophageal sphincter pressure was demonstrated, as well as an increase in the total length and abdominal length of this sphincter (p less than 0.0001). The increase in gastroesophageal sphincter was evaluated in 46 patients 1 year and 5 years after surgery, and this showed a maintenance of sphincter competence. Esophageal clearance markedly improved after surgery, and the standard acid reflux test, which was positive in 100% of cases before surgery, persisted positive in 16% (p less than 0.001). Final clinical evaluation 5 years after surgery demonstrated excellent and good results in 85% of the patients and failure or reoperation in 8% of the patients.