Fundoplications resist reflux independent of in vivo anatomic relationships.
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 degrees) and Toupet (270 degrees) 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.
Farrell
T M
TM
Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
Smith
C D
CD
Metreveli
R E
RE
Richardson
W S
WS
Johnson
A B
AB
Hunter
J G
JG
D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D004943:Esophagogastric Junction / Q000502:physiology* / Q000601:surgery*; D005260:Female; D018662:Fundoplication / Q000379:methods; D006801:Humans; D066298:In Vitro Techniques; D008297:Male; D011312:Pressure