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.)
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- 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
Accepted: July 29, 1999
*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.
© 2000 Mosby, Inc. Published by Elsevier Inc. All rights reserved.