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    For those with severe GERD, the Nissen fundoplication often provides the relief that they are unable to find with medication and lifestyle changes alone. Since 1991, this procedure has been increasingly performed laparoscopically, making it an even more popular procedure. However, this procedure often isn't appropriate for those with impaired esophageal peristalsis, which occurs in up to 25 percent of patients with mild disease and 50 percent of those with severe disease. In fact, this procedure could make symptoms worse in some of these patients.

    Recently, however, researchers from the University of Innsbruck in Austria and the Mayo Clinic in Jacksonville, Florida, determined that a modification of this procedure may provide relief for patients unable to benefit from the Nissen fundoplication.

    The laparoscopic partial posterior fundoplication is similar to the Nissen fundoplication, except that a portion of the front of the esophagus is left uncovered.

    These researchers studied a group of 78 consecutive GERD patients with poor esophageal contractility who underwent this procedure. At approximately 31 months after the surgery 76 patients reported being free of heartburn, and the rate of dysphagia, or difficulty swallowing, decreased from 49 percent before surgery to 10 percent after surgery. All patients were happy with the procedure and reported that they would be willing to undergo the same operation again if it became necessary.

    While the researchers were unable to determine if this surgery will be effective long-term, they did conclude that the partial posterior fundoplication is the preferred procedure in patients with impaired esophageal peristalsis. Their findings were published recently in the journal "Surgery."


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