title: Artificial phrenoesophageal ligament. An experimental study in dogs.
abstract: This report deals with the preparation of a 'true' artificial phrenoesophageal ligament aimed at restoring effective anchoring of the esophagus to the diaphragm, keeping the esophagogastric sphincter in the abdomen. A total of 24 mongrel dogs were assigned to four groups: (i) Group I (n = 4): the esophageal diaphragm hiatus left wide open; (ii) Group II (n = 8): the anterolateral esophagus walls were attached to the diaphragm by the artificial ligament and the esophageal hiatus was left wide opened; (iii) Group III (n = 5): in addition to the use of the artificial ligament, the esophageal hiatus was narrowed with two retroesophageal stitches; (iv) Group IV (n = 7): the only procedure was the esophageal hiatus narrowing with two retroesophageal stitches. The phrenoesophagogastric connections were released, sparing the vagus nerves. Five animals of groups III and IV, which did not develop hiatal hernia, were submitted to esophageal manometry immediately before and 15 days after surgery. In group I, all animals developed huge sliding hiatal hernias. In group II, two dogs (25%) had a paraesophageal hernia between the two parts of the artificial ligament. In group III, neither sliding hiatal hernia nor paraesophageal hernia occurred. In group IV, two animals (28.6%) developed sliding esophageal hiatus hernia. Regarding esophageal manometry, postoperative significant difference between groups III and IV (P = 0.008) was observed. Thus, the artificial phrenoesophageal ligament maintained the esophagus firmly attached to the diaphragm in all animals and the esophagogastric sphincter pressure was significantly higher in this group.
authors.affiliation: Department of Surgery and Anatomy, Laboratory of Surgical Research, Ribeirão Preto, São Paulo, Brazil.
authors.forename: A A
authors.initials: AA
authors.lastname: Sader
authors.affiliation: Department of Internal Medicine, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
authors.forename: R O
authors.initials: RO
authors.lastname: Dantas
authors.affiliation: Department of Surgery and Anatomy, Laboratory of Surgical Research, Ribeirão Preto, São Paulo, Brazil.
authors.forename: A D
authors.initials: AD
authors.lastname: Campos
authors.affiliation: Department of Surgery and Anatomy, Laboratory of Surgical Research, Ribeirão Preto, São Paulo, Brazil.
authors.forename: P R B
authors.initials: PR
authors.lastname: Evora
mesh_terms: D000818:Animals; D003964:Diaphragm / Q000601:surgery; D004285:Dogs; D004943:Esophagogastric Junction / Q000601:surgery; D004945:Esophagoscopy / Q000009:adverse effects / Q000379:methods*; D004947:Esophagus / Q000637:transplantation*; D006551:Hernia, Hiatal / Q000209:etiology; D020007:Implants, Experimental; D008022:Ligaments / Q000637:transplantation*; D008365:Manometry; D016896:Treatment Outcome
keywords: artificial phrenoesophageal ligament; esophageal hiatal hernia; gastroesophageal reflux disease; phrenoesophageal ligament