Fundoplications resist reflux independent of in vivo anatomic relationships

• Published in: The American journal of surgery Vol. 177; no. 2; pp. 107 - 110
• Main Authors: Farrell, Timothy M, Smith, C.Daniel, Metreveli, Ramaz E, Richardson, William S, Johnson, Alfred B, Hunter, John G
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.02.1999; Elsevier; Elsevier Limited
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Cadaver; Cadavers; Catheters; Distension; Dysphagia; Esophageal sphincter; Esophagogastric Junction - physiology; Esophagogastric Junction - surgery; Esophagus; Explants; Female; Fundoplication - methods; Gastroesophageal reflux; Humans; In Vitro Techniques; In vivo methods and tests; Independent variables; Male; Medical sciences; Physiology; Polygraphs; Pressure; Rupture; Sphincter; Stomach, duodenum, intestine, rectum, anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Sutures; Human; Manometry; Gastroesophageal reflux; Plication; Treatment; Esophageal sphincter; Surgery; Esophageal disease; Gastric fundus; Digestive diseases; Comparative study; Result
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/S0002-9610(98)00313-4

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°) and Toupet (270°) 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.