Long-term Follow-up of the Combined Fundic Patch Fundoplication for Treatment of Longitudinal Peptic Strictures of the Esophagus

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Abstract
Optimum treatment of patients with esophageal strictures requires a wide repertoire of procedures suited to the individual circumstance. The Thal-Nissen procedure should be used in the patient with a longitudinal transmural stricture which cannot be easily dilated. When used in this setting, it widens the distal esophagus with a patch of well vascularized fundus and provides extremely effective protection against gastroesophageal reflux. Sixty-eight patients at the University of Florida, Gainesville, Florida, USA, underwent combined Thal-Nissen procedures for longitudinal peptic strictures. Operative mortality rate was 4%. The average length of follow-up was 68 mo. Fifty-seven of 68 patients had an acceptable result (84%). Four % had an early recurrence of their strictures, while an additional 4% had late recurrence of their stricture after an initially good response period of from 2-11 yr. Four of the 6 patients with poor results had achalasia, scleroderma or diffuse esophageal spasm. The combined Thal-Nissen procedure represents the optimum therapy for the patient with an undilatable transmural stricture of the esophagus. When used in this setting, satisfactory results will be achieved in a large majority of patients with an extremely low operative mortality rate. Colonic or jejunal interposition should be reserved for those patients who fail to respond to a combined Thal-Nissen procedure or who demonstrate sufficiently disordered peristalsis to render the esophagus an unsatisfactory conduit for food passage.