title: The effect of total and anterior partial fundoplication on antireflux mechanisms of the gastroesophageal junction.
abstract: BACKGROUND
  The effect of total (Nissen) and anterior partial fundoplication (APF) for the surgical treatment of gastroesophageal reflux disease (GERD) on the motor behavior of the esophagogastric axis has not been fully assessed. The purpose of this study was to assess any alterations in lower esophageal sphincter (LES) and gastric fundus motor parameters in GERD patients after Nissen or APF fundoplication.
  
  
  METHODS
  Twenty four patients with documented GERD underwent either laparoscopic Nissen fundoplication (n = 12) or laparoscopic APF (n = 12). Preoperative and postoperative stationary esophageal manometry included assessment of LES resting and postdeglutition relaxation pressures, intragastric pressure, and LES transient relaxations in the left lateral and upright positions and after gastric distension.
  
  
  RESULTS
  Both types of fundoplication resulted in significant increases in LES resting (P <0.001) and postdeglutition relaxation pressure (P <0.001) in both positions and after gastric distention. Intragastric pressure increased only after Nissen fundoplication in the postgastric distention state (P = 0.01). Transient LES relaxations were equally abolished after both procedures. All postoperative changes were to a similar level after either procedure with the exception of intragastric pressure after gastric distention, which was significantly higher after total than after partial fundoplication (P = 0.04).
  
  
  CONCLUSIONS
  Both procedures equally increase LES resting and postdeglutition relaxation pressures and abolish transient LES relaxations at all states. The significantly higher intragastric pressure at the postgastric distention state after Nissen fundoplication could possibly explain the higher incidence of epigastric fullness and discomfort after this type of antireflux surgery.
authors.affiliation: Laboratory of Gastrointestinal Motility, University Hospital of Heraklion, GR-711 10 Heraklion, Crete, Greece. chrysos@med.uoc.gr
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Chrysos
authors.forename: Elias
authors.initials: E
authors.lastname: Athanasakis
authors.forename: George
authors.initials: G
authors.lastname: Pechlivanides
authors.forename: Anastasios
authors.initials: A
authors.lastname: Tzortzinis
authors.forename: Apostolos
authors.initials: A
authors.lastname: Mantides
authors.forename: Evaghelos
authors.initials: E
authors.lastname: Xynos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004943:Esophagogastric Junction / Q000503:physiopathology*; D005260:Female; D018662:Fundoplication / Q000009:adverse effects* / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011312:Pressure; D018709:Statistics, Nonparametric