Fundoplications resist reflux independent of in vivo anatomic relationships

Timothy M. Farrell, C. Daniel Smith, Ramaz E. Metreveli, William S. Richardson, Alfred B. Johnson, John G. Hunter

Research output: Contribution to journalArticle

15 Scopus citations

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 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.

Original languageEnglish (US)
Pages (from-to)107-110
Number of pages4
JournalAmerican journal of surgery
Volume177
Issue number2
DOIs
StatePublished - Feb 1 1999

ASJC Scopus subject areas

  • Surgery

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    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