HP32P OESOPHAGEAL PH PROFILE FOLLOWING PARTIAL AND TOTAL LAPAROSCOPIC FUNDOPLICATION

Abstract

Purpose In Barrett’s oesophagus, it may be that total abolition of reflux will give maximal protection against the development of malignancy. It is not known whether a laparoscopic partial fundoplication gives the same degree of acid reflux control as a Nissen fundoplication. This study was undertaken to answer that question.Methodology A retrospective analysis of a prospectively followed cohort of patients who had undergone laparoscopic fundoplication as a part of clinical trials that required patients to return for routine oesophageal pH testing within 6 months of surgery. Parameters studied were percentage time pH < 4 and total number of reflux episodes compared against wrap types.Results A total of 167 patients had routine post‐operative oesophageal pH testing, of which 123 had had laparoscopic Nissen fundoplication and the remaining 44 had partial wraps. The total number of reflux episodes was significantly different between the full and partial wrap types (p = 0.026), with a median of 4 refluxes for full wrap and 6 for partial wraps. However, there was no significant difference in the percentage time pH < 4 between wrap types (p = 0.08). In patients with two post‐operative pH studies done at least 5 years apart, there was no significant difference in the parameters both within and between wrap types over time.Conclusion Although there was a significant difference in the number of reflux episodes between a full wrap and a partial wrap, it is hard to see this as biologically or clinically significant. Furthermore none of the other parameters showed a statistically significant difference. This study does not support the view that a total fundoplication gives more effective reflux control than a partial fundoplication.