TY - JOUR
T1 - Fundoplications resist reflux independent of in vivo anatomic relationships
AU - Farrell, Timothy M.
AU - Smith, C. Daniel
AU - Metreveli, Ramaz E.
AU - Richardson, William S.
AU - Johnson, Alfred B.
AU - Hunter, John G.
PY - 1999/2
Y1 - 1999/2
N2 - 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 corn pared 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.
AB - 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 corn pared 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.
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U2 - 10.1016/S0002-9610(98)00313-4
DO - 10.1016/S0002-9610(98)00313-4
M3 - Article
C2 - 10204550
AN - SCOPUS:0032997416
SN - 0002-9610
VL - 177
SP - 107
EP - 110
JO - American journal of surgery
JF - American journal of surgery
IS - 2
ER -