Randomized trial of division versus nondivision of the short gastric vessels during laparascopic Nissen fundoplication - 10-year outcomes

Background: Although laparoscopic Nissen fundoplication is an effective procedure for the treatment of gastroesophageal reflux, in some patients it is followed by troublesome side effects, such as dysphagia, abdominal bloating, and inability to belch. It has been claimed that dividing the short gastric blood vessels during laparoscopic Nissen fundoplication minimizes the risk of these problems. We have previously reported the 6-month and 5-year outcomes from a randomized trial, which have shown no advantages after division of these vessels. In this study, we determined the longer-term (10 years) outcomes from this trial. Methods: From May 1994 to October 1995, 102 patients with gastroesophageal reflux disease who underwent a laparoscopic Nissen fundoplication were entered into this randomized trial (vessels divided in 50, not divided in 52). At 10-year follow-up, 88 patients provided clinical follow-up information. Follow-up was obtained by telephone interview conducted by an independent and blinded investigator who applied a standardized questionnaire. Results: At 10-year follow-up no significant differences between the 2 groups could be identified. Heartburn, dysphagia, and overall satisfaction were similar for both study groups. Conclusions: The 10-year clinical outcomes from this trial have shown no benefit for division of the short gastric vessels during laparoscopic Nissen fundoplication.