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Original Article
July 1, 2006

Impact of Laparoscopic Nissen Fundoplication With Prosthetic Hiatal Closure on Esophageal Body Motility: Results of a Prospective Randomized Trial

Author Affiliations

Author Affiliations: Department of General, Visceral, and Transplant Surgery, University Hospital of T[[uuml]]bingen, T[[uuml]]bingen, Germany (Dr Granderath); and Department of General Surgery and Division of Clinical Psychology, General Hospital Zell am See, Zell am See, Austria (Drs Kamolz, Schweiger, and Pointner).

Arch Surg. 2006;141(7):625-632. doi:10.1001/archsurg.141.7.625

Hypothesis  Prosthetic crural closure does not adversely influence esophageal body motility. In most patients, postoperative increased dysphagia resolves spontaneously during the first months after surgery.

Design  Prospective randomized trial. We compared patients who underwent laparoscopic Nissen fundoplication with simple sutured hiatal closure and those who underwent laparoscopic Nissen fundoplication with prosthetic hiatal closure.

Setting  University-affiliated community hospital.

Patients  Forty consecutive patients who underwent laparoscopic Nissen fundoplication for gastroesophageal reflux disease.

Interventions  A 360° Nissen fundoplication with simple sutured crura (n = 20; nonmesh group) vs the same procedure with posterior 1 × 3-cm polypropylene onlay mesh prosthesis (n = 20; mesh group).

Main Outcome Measures  Recurrences; postoperative dysphagia rate; localization, length, and pressure of the lower esophageal sphincter (LES); results of 24-hour pH monitoring; esophageal body motility; peristalsis; and esophageal amplitude of contraction and interrupted waves.

Results  Preoperatively, both groups had pathological LES pressure and DeMeester scores. These values improved significantly (P<.01) after surgery and remained stable at 1 year after surgery. Patients in the nonmesh group had a significantly lower LES pressure 1 year after surgery compared with those in the mesh group. There were no significant differences in postoperative mean LES length (4.1 vs 3.8 cm), LES relaxation (93.4% vs 92.4%), and intra-abdominal LES length (2.1 vs 2.1 cm). Patients in the mesh group had fewer simultaneous waves and interrupted waves 1 year after surgery, but the difference between groups was not significant. There were no significant differences in interrupted waves and amplitude of contraction between groups 1 year after surgery.

Conclusion  Laparoscopic Nissen fundoplication with prosthetic crural closure does not impair postoperative esophageal body motility compared with laparoscopic Nissen fundoplication with simple suture hiatal closure, although it is associated with a higher rate of short-term dysphagia.