Effects of partial (Belsey Mark IV) and complete (Nissen) fundoplication on proximal gastric function and esophagogastric junction dynamics.
OBJECTIVE
This study aimed to assess the effects of Belsey Mark IV 270 degrees (partial) and Nissen 360 degrees (complete) fundoplication on proximal stomach function, transient lower esophageal sphincter relaxation (TLESR) elicitation and the esophagogastric junction (EGJ) pressure profile during TLESR to further elucidate the mechanism of action of fundoplication.


METHODS
Ten patients after partial and 10 patients after complete fundoplication were studied. High-resolution EGJ manometry and pH recording were performed for 1 h at baseline and 2 h following meal ingestion (500 mL/300 kcal). Three dimensional (3D) ultrasonographic images of the stomach were acquired every 15 min after meal ingestion. From the 3D ultrasonographic images, proximal gastric volumes were computed.


RESULTS
Postprandial proximal to complete gastric volume distribution ratios were larger among patients after partial (0.42 +/- 0.028) compared with patients after complete fundoplication (0.37 +/- 0.035; p < 0.05). Partial fundoplication patients had a markedly greater postprandial rate of TLESR (1.7 +/- 0.3/h) than patients after complete fundoplication (0.8 +/- 0.2/h; p < 0.05). The axial EGJ pressure profile was minimally affected by partial fundoplication but instead markedly changed after complete fundoplication.


CONCLUSIONS
Patients after partial fundoplication exhibit a larger meal-induced increase in proximal stomach volume, a higher TLESR rate, and a minimally affected axial EGJ pressure profile compared to patients after complete fundoplication.
Gastrointestinal Research Unit, Departments of Surgery and Gastroenterology, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands.
Robert C H
RC
Scheffer
Melvin
M
Samsom
Geoff S
GS
Hebbard
Hein G
HG
Gooszen
D000328:Adult; D000368:Aged; D004943:Esophagogastric Junction / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005745:Gastric Acidity Determination; D005748:Gastric Fundus / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005764:Gastroesophageal Reflux / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D010535:Laparoscopy; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D019518:Postprandial Period / Q000502:physiology; D014463:Ultrasonography