Outcome effect of adherence to operative principles of Nissen fundoplication by multiple surgeons. Discussion. Comment

Fifty-eight patients participated in a multi-institutional study designed to assess the outcome of Nissen fundoplication when performed for complicated disease by a variety of surgeons with varied skill and experience with compliance to established technical principles. All patients had an abnormal 24-hour pH study and mucosal injury on endoscopy. The surgical procedures were performed in 8 Veterans Administration hospitals by surgical residents supervised by surgical faculty, after initial agreement on 10 operative principles for the Nissen fundoplication