Endolaparoscopic approach in the management of gastroesophageal reflux disease: an experimental study in pigs.
BACKGROUND
Chronic reflux of gastric content to the esophagus causes retrosternal burning, pain, and regurgitation, and results in histopathologic changes that may culminate in adenocarcinoma. Insufficiency of the lower esophageal sphincter and hiatal hernia are the two principal causative factors. In this paper, we present the early results of a new antireflux operation in pigs.


METHODS
The status of physiologic reflux was determined in 5 pigs (approximately 40-45 kg) with 24-hour pH monitorization. Under endoscopic guidance, a trocar was inserted into the stomach (similar to the percutaneous endoscopic gastrostomy technique). The endoscope was put into the retroflexed position; a mucomuscular pursestring suture was placed around the endoscope at the cardia and tied. Ten days later, pH monitorization was repeated to evaluate the effectiveness of the method. Late postoperative results have been reevaluated by 24-hour pH monitorization in the sixth month.


RESULTS
The procedure achieved statistically significant improvements in total reflux time, number of reflux periods, number of long reflux periods, the longest reflux period, and the DeMeester score. The preoperative and postoperative DeMeester scores of the individual animals were 179.24-0.94, 11.48-0.98, 68.4-3.74, 132.2-46.49, and 38.72-5.86, respectively. Even though there appeared to be a slight increase in the pH monitorization levels after 6 months, these results did not reach significant degrees, and compared to the physiological reflux, the results were remarkable.


CONCLUSIONS
The results obtained showed considerable decreases in physiologic reflux in all animals. We believe that this endoluminal, laparoendoscopic operation can be used in the treatment of gastroesophageal reflux disease as a minimally invasive method.
Sari
Yavuz Selim
YS
Department of General Surgery, SB Istanbul Egitim ve Arastirma Hastanesi, Istanbul, Turkey. yssari@hotmail.com
Koc
Oguz
O
Tunali
Vahit
V
Erkan
Esin
E
Uzum
Gungor
G
Sayilgan
Cem
C
Koksal
Guniz
G
Ugurlu
Serdal
S
D000818:Animals; D004195:Disease Models, Animal; D004945:Esophagoscopy; D005260:Female; D005764:Gastroesophageal Reflux / Q000601:surgery*; D005773:Gastroscopy; D006863:Hydrogen-Ion Concentration; D010535:Laparoscopy / Q000379:methods*; D008991:Monitoring, Physiologic; D018709:Statistics, Nonparametric; D013552:Swine