It has been suggested that division of the short gastric vessels (SGV) provides a more floppy Nissen fundoplication, for the treatment of reflux disease.
A study conducted by members of the Department of General Surgery and Laboratory of Gastrointestinal Motility, at the University of Crete Medical School in Crete, Greece, has examined whether Nissen fundoplication with division of SGV is associated with improved clinical outcome and laboratory findings.
The research team selected 56 consecutive patients with gastroesophageal reflux disease (GERD). They then randomly assigned them to have a laparospcopic Nissen fundoplication, either with division (24 patients; 15 men; mean age 51 years), or without division (32 patients: 23 men: mean age 47 years) of the SGV.
Preoperative and postoperative investigation included clinical assessment, esophagoscopy, esophagogram, esophageal manometry, and 24-hour ambulatory esophageal pH monitoring.
In both groups, reflux was abolished following the procedure. However, division of the SGV was found to result in a significant increase in the operating time.
| SGV division associated with gas-bloating syndrome.
| American Journal of Surgery |
Both types of Nissen fundoplication significantly increased the amplitude of peristalsis at the distal esophagus.
In the SGV division group, this increase was from 56 mm Hg to 64 mm Hg, while in the non-division group the increase was from 65 mm Hg to 75 mm Hg.
In addition, lower esophageal sphincter pressure also rose following both procedures (division group 16 to 24 mm Hg; non-division group 22 to 28 mm Hg).
There were no differences in the incidence of either postoperative severe dysphagia or overall esophageal transit between the two groups.
However, division of the SGV was associated with a significant increased incidence of gas-bloating syndrome.
A total of 13 patients out of 24 in the division group suffered from this problem, compared with only 9 cases out of the 32 patients in the non-division group.
The research group concludes from their findings that division of the SGV at laparoscopic Nissen fundoplication for GERD does not improve clinical outcome and laboratory findings. It is associated with prolongation of the operating time and increased incidence of gas-bloating syndrome.