Abstract
Objectives: This study compared the pressure topography after laparoscopic Nissen fundoplication
to that of normal subjects and patients with hiatal hernia and reflux disease. Methods: Seven patients with fundoplication, 7 normal subjects and 7 patients with hiatal
hernia, were studied. The squamocolumnar junction and intragastric margin of the esophagogastric
junction (EGJ) were marked with metal clips. Axial and radial characteristics of EGJ
pressure were mapped relative to the hernia and clipped during concurrent fluoroscopy
and manometry. Responses to inspiration and abdominal compression were also analyzed.
Results: Fundoplication modifies the EGJ by restoration of the hiatal component of EGJ pressure
and elongation of the subdiaphragmatic component. Maximal EGJ pressure after fundoplication
is mainly dependent on the extrinsic effect of the hiatal canal that compresses the
esophagus; the resultant length of the EGJ reflects the length of the fundic wrap.
Integrity of the EGJ after fundoplication is independent of the intrinsic lower esophageal
sphincter itself. Conclusions: Fundoplication alters the pressure topography of the EGJ by reducing the hiatal hernia,
tightening the hiatal orifice, and constructing a subdiaphragmatic wrap of variable
length. Each effect depends on different technical aspects of the surgery with the
potential of substantial variability in the resultant pressure topography. (Surgery
2000;127:200-8.)
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- A physiologic approach to laparoscopic fundoplication for gastroesophageal reflux disease.Ann Surg. 1996; 223: 673-677
- A study of 362 consecutive laparoscopic Nissen fundoplications.Surgery. 1998; 124: 651-655
- Laparoscopic Nissen fundoplication: Where do we stand?.Surg Laparosc Endosc. 1997; 7: 17-21
- The gastroesophageal flap valve: in vitro and in vivo observations.Gastrointest Endosc. 1996; 44: 541-547
- Interactive computer program for biomechanical analysis of videoradiographic studies of swallowing.Am J Roentgenol. 1989; 153: 277-280
- Esophageal manometry in the opossum.Am J Physiol. 1977; 233: E152-E159
- Sphincterlike thoracoabdominal high pressure zone after esophagogastrectomy.Gastroenterology. 1993; 105: 1362-1369
- The effect of hiatus hernia on gastro-oesophageal junction pressure.Gut. 1999; 44: 483-489
- Oesophageal motility before and after laparoscopic Nissen fundoplication.Br J Surg. 1997; 84: 1465-1469
- Nissen fundoplication for gastroesophageal reflux disease: evaluation of primary repair in 100 consecutive patients.Ann Surg. 1986; 204: 9-20
- The treatment of gastroesophageal reflux disease with laparoscopic Nissen fundoplication: prospective evaluation of 100 patients with “typical” symptoms.Ann Surg. 1998; 228: 40-50
- Muscular equivalent of the lower esophageal sphincter.Gastroenterology. 1979; 76: 31-39
- Laparoscopic Nissen fundoplication is an effective treatment for gastroesophageal reflux disease.Ann Surg. 1994; 220: 472-483
- Dysphagia after laparoscopic antireflux surgery: impact of operative technique.Ann Surg. 1996; 224: 51-57
- The floppy Nissen fundoplication.Arch Surg. 1985; 120: 663-668
- Three-dimensional imaging of the lower esophageal sphincter in gastroesophageal reflux disease.Ann Surg. 1991; 214: 374-384
- Upper esophageal sphincter function during belching.Gastroenterology. 1986; 91: 133-140
- Control of belching by the lower oesophageal sphincter.Gut. 1990; 31: 639-646
- Response of canine lower esophageal sphincter to gastric distension.Am J Physiol. 1990; 259: G380-G385
Article info
Publication history
Accepted:
July 29,
1999
Footnotes
*Supported by grant RO1 DC00646 (P.J.K.) from the Public Health Service.
**Reprint requests: Peter J. Kahrilas, MD, Northwestern University Medical School, Division of Gastroenterology & Hepatology, Department of Medicine, Searle Building, 10th Floor, Suite 541, 303 East Chicago Ave, Chicago, IL 60611-3008.
Identification
Copyright
© 2000 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
