Fundoplications resist reflux independent of in vivo anatomic relationships.

Abstract:

BACKGROUND:Antireflux operations restore lower esophageal sphincter (LES) function and hiatal anatomy; however, the relative contributions are unclear. METHODS:We measured the competency of fundoplications, exclusive of in vivo variables, in gastroesophageal explants from 8 cadavers. Using a multichannel manometer, esophageal, LES, and intragastric pressures were recorded during transpyloric distension. Data were compared at baseline, and after Nissen (360 degrees) and Toupet (270 degrees) fundoplications. RESULTS:Before fundoplication, stomachs refluxed immediately upon distension. Nissen fundoplications never refluxed before gastric rupture (46.8 +/- 15.0 mm Hg). LES pressure averaged 2.0 +/- 0.5 times intragastric pressure during distension. Toupet fundoplications refluxed at intragastric pressure <2 mm Hg, then became competent until gastric rupture (49.9 +/- 15.0 mm Hg). LES pressure averaged 2.4 +/- 1.0 times intragastric pressure during distension. CONCLUSIONS:Nissen and Toupet fundoplications increase LES pressure linearly at 2 to 2.5 times intragastric pressure, independent of in vivo variables. Toupet fundoplication lacks the competency of Nissen fundoplication at low intragastric pressures.

journal_name

Am J Surg

authors

Farrell TM,Smith CD,Metreveli RE,Richardson WS,Johnson AB,Hunter JG

doi

10.1016/s0002-9610(98)00313-4

subject

Has Abstract

pub_date

1999-02-01 00:00:00

pages

107-10

issue

2

eissn

0002-9610

issn

1879-1883

pii

S0002-9610(98)00313-4

journal_volume

177

pub_type

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