[Fundus plication with or without proximal selective vagotomy?].

The aim of this study was to determine the influence of proximal gastric vagotomy on the outcome after fundoplication. Of 141 patients operated on for reflux disease between 1972 and 1988, 53 had fundoplication alone (group A) and 88 fundoplication combined with proximal gastric vagotomy (group B). The two groups were similar with regard to the severity of the reflux disease (esophagitis: A 69%, B 73%) but had a different incidence of concomitant ulcer disease (A 2%, B 55%). After a mean follow-up of 9 years, 111 patients (79%) were evaluated by clinical examination and 57 patients (40%) by endoscopy. Perioperative morbidity was similar (A 22%, B 19%). Successful reflux control (A and B 81%) and overall clinical outcome (Visick I and II: A 78%, B 80%) were identical. The frequency of adverse side effects was approximately the same in both groups (dysphagia: A 28%, B 26%; gas-bloat: A 52%, B 37%). We conclude that the long term results after fundoplication are not improved by additional proximal gastric vagotomy. The combined procedure is therefore only justified if both reflux disease and ulcer disease are present.