Fundoplications resist reflux independent of in vivo anatomic relationships.
Publication/Presentation Date
2-1-1999
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 pressureHg, 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.
Volume
177
Issue
2
First Page
107
Last Page
110
ISSN
0002-9610
Published In/Presented At
Farrell, T. M., Smith, C. D., Metreveli, R. E., Richardson, W. S., Johnson, A. B., & Hunter, J. G. (1999). Fundoplications resist reflux independent of in vivo anatomic relationships. American journal of surgery, 177(2), 107–110. https://doi.org/10.1016/s0002-9610(98)00313-4
Disciplines
Medicine and Health Sciences
PubMedID
10204550
Department(s)
Fellows and Residents
Document Type
Article