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Nissen fundoplication gives lasting relief from symptoms of gastro-oesophageal reflux and cures endoscopic oesophagitis effectively. The histological effect on the oesophageal mucosa is less clear. We studied the long-term histological effect of Nissen fundoplication on refractory gastro-oesophageal disease with erosive oesophagitis or Barrett's metaplasia in 33 patients with biopsy both before and after antireflux surgery. The median postoperative interval to re-examination was 80 (range 37-110) months. Symptoms of reflux were greatly relieved; 31 (94%) of the 33 patients had none or, at the most, mild symptoms. Endoscopic oesophagitis was healed in 26 (79%) of the cases. The histological appearance of the oesophageal mucosa had been abnormal in all the patients preoperatively, but at follow-up it was normal in 22 cases (67%): in 89% of the patients without objectively observed recurrent reflux and in 45% of those with recurrence. Both the pre- and postoperative severity of the histological changes correlated significantly with the endoscopic grade of oesophagitis (r=0.42, P=0.017 and r=0.837, P=0.0001, respectively), but not with the clinical reflux score. In conclusion, Nissen fundoplication resulted in histological healing in the great majority of patients with oesophagitis.

Objective: To assess the effect on postoperative dysphagia and oesophageal transit of fundal mobilisation during Nissen-Rossetti fundoplication., Design: Prospective, randomised study., Setting: University Hospital, Finland., Subjects: 20 consecutive patients with confirmed gastro-oesophageal reflux who were referred for antireflux surgery., Interventions: Fundoplication with either conventional Nissen-Rossetti procedure or an otherwise identical technique incorporating total fundal mobilisation (n = 10 in each group)., Main Outcome Measures: Recurrent or persistent symptoms of dysphagia, and the oesophageal transit time of a liquid bolus labelled with radioactive nuclide., Results: In both groups excellent relief of heartburn and regurgitation was achieved (only 2 patients in each group reported occasional symptoms), one patient had oesophagitis, and the pH returned to the normal range. The incidence of dysphagia was similar in both groups by 6 months postoperatively, but there was significant, though transient, impairment of oesophageal transit after findal mobilisation (p = 0.03)., Conclusions: Fundal mobilisation did not seem to confer any advantage as fas as the incidence of postoperative dysphagia was concerned. On the contrary, it was associated with transient disturbance in the oesophageal transit time of a liquid bolus. Longer follow up is needed to show if this impairment is of any clinical relevance.