EVALUATION OF THE TAILORING CONCEPT OF OESOPHAGEAL ANTIREFLUX SURGERY

Background: A variety of antireflux operations exists for patients with gastroesophageal reflux disease. However, 
controversy exists with regard to the choice of operation between complete 360o Nissen Fundoplication versus partial 270o Toupet fundoplication. Most surgeons operate using the concept of “tailored approach”, which depends on the degree of preexisting oesophageal motility. Some recent studies abandoned this approach since “tailoring” the operation does not prevent dysphagia occurrence. In view of the still controversial opinion regarding the tailoring concept of antireflux procedure, this prospective, randomized study was done to evaluate the two operative techniques with the objective to determine the impact of preoperative normal and abnormal oesophageal motility on the outcome. 
Methods: The present study was conducted on eighteen patients with chronic symptomatic GORD. The preoperative 
assessment included clinical evaluation, radiological study, upper gastro- intestinal endoscopy with biopsy, and oesophageal manometry with ambulatory PH monitoring. Surgery (9 Nissen and 9 Toupet fundoplication) was performed laparoscopically in fourteen patients and by the conventional open technique in the rest. Surgeries were done in a randomized fashion regardless of the motility status. The perioperative data and complications were compared between the two surgical groups. 
Follow up was done at one, three and six months using the same preoperative clinical, radiological, endoscopic and 
manometry studies and the results were compared between the two motility groups. 
Results: Oesophageal dysmotility did not affect the outcome after either Nissen or Toupet fundoplication in that 
improvement and relief of heartburn and regurgitation as well as reflux control on 24-hour pH monitoring and healing of oesophagitis were similar in patients with both normal and abnormal oesophngeal motility. 
Conclusion: Tailoring antireflux surgery to oesophageal motility is not indicated, since motility disorders are not correlated with postoperative dysphagia.