| Objective: Gastroesophageal reflux disease (GERD) is the most commen abnormality in gastroesophageal disorders. Complications develop in approximately 50% of patients with abnormal gastroesophageal reflux including oesophagitis, oesophageal stricture, Barrett′s esophagus. Proton-pump inhibitors can cure oesophagitis effectively by reducing the gastric acid secretion. But continuous therapy is necessary to prevent relapse and normal antireflux barrier can not be restored by medication. Antireflux surgery should be performed for patient who is ineffective to the medication. At present, the information of long-term outcome of antireflux procedure is not available in China. The outcome of antireflux procedure is usually assessed in our country by subjective symptoms in the literature, lacking objective evidence. This study is to assess the long-term outcomes of antireflux procedures objectively by using esophageal manometry, 24-hour esophageal pH monitoring and fiberoptic esophagoscopy. Materials and Methods: Between November 1988 and January 2001, 126 patients with GERD underwent antireflux procedures in the Fourth Hospital, Hebei Medical University, including sliding hernia in 103 patients, short oesophagus with hiatus hernia in 11, paraesophageal hernia in 9, mixed hiatus hernia in 3. Follow-up study was carried out by telephone or correspondence. Ninty-two patients were followed up for a median of 10 years (range 1 to 14 years),0 could not be followed and 4 died of the causes unrelated to the disease. There were 53 males and 39 females, with a median age of 58 years (range 24 to 81 years). Nissen fundoplication was performed for 44, COI procedure for 33, Belsey Mark Ⅳ, Toupet, Thor, Dor for 10, 1, 1, respectively. Ninety-two patients were inquired about symptoms of postoperative heartburn, regurgitation, dysphagia and the symptoms were scored according to symptom degree, each symptom was scored for 4 grade: 0-3. Cinical score was calculated as total score of each symptom, thus the highest score is 9. The efficacy of operation was evaluated according to the criteria proposed by Kjell: excellent (no symptoms), good (symptom occured occasionally and the patient need not take medicine), fair (minor or no improvement) and poor (symptoms as bad or worse than preoperatively). Esophageal manometry study, esophagoscopy and 24-hour esophageal pH monitoring were carried out successfully in 51, 48, 35, respectively at follow-up. According to antireflux procedures the patients were divided into three groups: Nissen fundoplication, Cardiac oblique invagination (COI) and Belsey Mark Ⅳ. The postoperative symptom scores and the outcomes of the postoperative objective examinations were compared with preoperative values to assess the long-term outcome of antireflux procedures. Results: ①The rate for long-term excellent or good relief of symptoms was 88.0% in 92 patients. The corresponding figure was 90.9% in Nissen fundoplication, 87.9% in COI, 70.0% in Belsey Mark Ⅳ. Dysphagia appeared in 4.5% in Nissen fundoplication, 0 in COI and Belsey Mark Ⅳ respectively(P=0.000). ②Clinical symptom scores reduced from 4.10±0.428 before surgery to 1.08±1.051 after surgery, with significant difference(P=0.000). ③DeMeester scores of 24-hour esophageal pH monitoring decreased from 43.82±30.50 preoperatively to 20.36±19.83 postoperatively (P=0.000). ④LES pressure increased from 12.92±5.93 mmHg preoperatively to 18.86±5.41mmHg postoperatively (P=0.000).⑤Preoperative contracting pressure of the esophagus body was 47.33±19.98 mmHg, and postoperative one is 46.55±17.07 mmHg with no significant difference(P= 0.814)。Conclusion: ①Efficacy of antireflux procedure is long lasting with excellent or good relief of symptoms in 88.0% of patients. The long-term excellent or good results was 90.9% in Nissen fundoplication, 87.9% in COI, 70.0% in Belsey Mark Ⅳ. Dysphagia appeared in 4.5% in Nissen fundoplication, 0 in COI and Belsey Mark Ⅳ respectively. ②Antireflux procedure can restore antireflux barrier an...
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