SURGICAL-TREATMENT OF REFLUX ESOPHAGITIS - NISSEN VERSUS THAL PROCEDURE

The Nissen fundoplication has been the most commonly used procedure in the surgical management of reflux esophagitis. Due to unsatisfactory results and the many complications of the Nissen procedure, in 1989 we began using the Thal partial wrap. In a retrospective study, the results from both procedures are compared. Between August 1982 and May 1991, antireflux operations (27 Nissen; 23 Thal) were performed in 44 children. Fifty-eight percent had associated conditions, neurological impairment (12) and esophageal atresia being the most frequent. An uneventfull postoperative course was seen in 29.6% after the Nissen fundoplication and 87% in the Thal group (P < 0.5). Recurrence or persistence of gastroesophageal reflux was observed in 37% and 4% of the Nissen and Thal groups, respectively. The symptom-free interval following the antireflux procedure averaged 11 months in the Nissen group and 2.8 months in the Thal group. Three out of 4 neurologically impaired children with a Nissen fundoplication had postoperative complications compared to 2 out of 8 with a Thal partial wrap. Eight children, all with a Nissen fundoplication, had to be reoperated for either acute obstruction or a redo procedure. The mean hospitalization times for the Nissen and Thal procedures were 16 and 7.6 days, respectively (P < 0.1). From our experience, the Thal partial fundoplication appears to be an effective antireflux procedure with fewer perioperative complications than the Nissen operation. In the neurologically impaired child with feeding problems and reflux, a Thal fundoplication in combination with a gastrostomy is our therapy of choice.