title: Esophagogastric junction pressure topography after fundoplication.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Medicine, Northwestern University Medical School, Chicago, Ill. 60611-3008, USA.
authors.forename: P J
authors.initials: PJ
authors.lastname: Kahrilas
authors.forename: S
authors.initials: S
authors.lastname: Lin
authors.forename: M
authors.initials: M
authors.lastname: Manka
authors.forename: G
authors.initials: G
authors.lastname: Shi
authors.forename: R J
authors.initials: RJ
authors.lastname: Joehl
mesh_terms: D000328:Adult; D004943:Esophagogastric Junction / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D005471:Fluoroscopy; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D006551:Hernia, Hiatal / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008365:Manometry; D011312:Pressure