Abstract

Objective: Belsey Mark IV (BM) and Total Fundoplication Gastroplasty (TFG) were the standard antireflux procedures in two consecutive periods in this specialist Thoracic surgery unit. The aim of this study was to compare the long term results obtained by these two procedures in relation to the severity of the oesophagitis.

Patients and Methods: Between 1976 and 1983 90 patients, 50 females and 40 males with a mean age of 57 years underwent a BM IV operation. From 1983 to 1986, 86 patients, 46 females and 40 males, with a mean age of 56.5 years underwent a TFG procedure. The oesophagitis was pre-operatively assessed endoscopically into four grades. The unit policy is for life long follow up. The symptoms at review were assessed and graded according to previously published criteria*. Patients with recurrent symptoms were fully re-investigated.

Results: In the BM IV group there was one post-operative death (1.1%). The median follow up was 78 months. Overall good results were achieved in 75.3% of cases. In patients without oesophagitis (n = 24) the success rate was 91.7% while for grades 1 (n = 17), 2--3 (n = 36) and 4 (n = 12) oesophagitis this was 76.5%, 72.2% and 50% respectively. In TFG group there was no postoperative death. The median follow up was 120 months. Overall good results were achieved in 90.4% of cases. In the absence of oesophagitis (n = 10) the succes rate was 90% and for grades 1 (n = 12), 2--3 (n = 26) and 4 (n = 38) of oesophagitis this was 91.6%, 91.6% and 89.4% respectively. The differences in the overall (p = 0.008) and the success rates for grades 2--3 (p = 0.04) and 4 (p = 0.002) oesophagitis were significant.

Conclusion: These data provide strong evidence on the superiority of the TFG against the BM IV in achieving long term relief of reflux symptoms in the presence of severe oesophagitis. We believe that failure of BM IV in this setting is due to obvious or subtle oesophageal shortening.