An Analysis of Recurrent Esophagitis Following Posterior Gastropexy

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Abstract
Surgical therapy for reflux esophagitis remains controversial. Patients (65) who underwent posterior gastropexy between Nov., 1970 and Feb., 1976 are presented. Indications for surgery were: esophagitis, 43 patients, esophagitis with stricture, 12 patients; paraesophageal hernia, 7 patients; incapacitating postfundoplication syndrome, 3 patients. The average follow-up was 15.6 mo. Of the patients, 82% had a good to excellent result, and 23% of the patients developed radiographically recurrent hiatus hernia; the incidence of recurrent esophagitis was only 9%. Two patients developed postoperative strictures (1 de novo, 1 recurrent). Two patients ultimately required a fundoplication for control of their esophagitis and 1 patient required a Thal-Nissen procedure. Lower esophageal sphincter pressure on patients with satisfactory results increased from 6.3 .+-. 1.3 cm H2O SEM [standard error of the mean] preoperatively, to 17.4 .+-. 3.0 cm H2O SEM postoperatively. This increase achieved a statistical significance of P < 0.001. In patients who had an unsatisfactory result, postoperative sphincter pressures were unchanged from preoperative values. All unsatisfactory results were obtained in patients with complicated esophagitis, i.e., Barrett''s ulcer or stricture, alkaline esophagitis or previous hiatal surgery. Posterior gastropexy appears to constitute effective therapy in the treatment of uncomplicated reflux esophagitis and paraesophageal hiatus hernia without the morbidity associated with the postfundoplication syndrome.