[Long-term results following fundus plication and vagotomy in reflux disease. Complaints after 10-20 years].

In 109 patients with primary reflux disease in whom combined fundoplication and vagotomy had been performed, the clinical results were evaluated by questionnaire 10-20 years (median 15.7 years) after operation. Indication for additional vagotomy was severe reflux disease and/or increased gastric acid output in 56 (A) and coexistent ulcer disease in 53 (B) patients. Vagotomy was truncular (with pyloroplasty) in 49, selective gastric (with pyloroplasty) in 50, and proximal gastric in 10 patients. Follow-up was available from 64 patients (59.6%). The results were as follows: 17.2% (A 19.4%, B 7.1%) had reflux symptoms, while 9.5% (A 11.4%, B 7.1%) needed medical antireflux therapy. Dysphagia was present in 28.2% (A 13.9%, B 35.7%), and gas-bloat in 54.7% (A 55.5%, B 53.6%). Typical postvagotomy symptoms were diarrhea in 23.5% (A 30.6%, B 14.3%) and dumping in 25.0% (A 22.2%, B 28.6%). Using the Visick classification criteria we found grade I and II in 73.4%, grade III in 17.2% and IV in 9.4%. Symptoms are frequent after fundoplication and vagotomy. The clinical result is more favourable in group B and for the combination of fundoplication with proximal gastric vagotomy.