CHAPTER 3
presence of oesophagitis and LOS pressure. Patients with good oesophageal peristalsis or low supine acid exposure before antireflux surgery have a lower risk of recurrent pathological acid exposure. Nissen fundoplication should not not necessarily be withheld from patients with poor oesophageal peristalsis or excessive supine acid exposure. As about one in every two patients with both these variables will experience recurrent pathological acid exposure after primary Nissen fundoplication, surgery in this group should be restricted. Careful counselling is necessary and can be optimized based on the present results, by providing patients with differentiated information on individual risk of recurrence and reoperation for reflux.
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