Document Detail


The effect of total and anterior partial fundoplication on antireflux mechanisms of the gastroesophageal junction.
MedLine Citation:
PMID:  15219483     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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:
Emmanuel Chrysos; Elias Athanasakis; George Pechlivanides; Anastasios Tzortzinis; Apostolos Mantides; Evaghelos Xynos
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  American journal of surgery     Volume:  188     ISSN:  0002-9610     ISO Abbreviation:  Am. J. Surg.     Publication Date:  2004 Jul 
Date Detail:
Created Date:  2004-06-28     Completed Date:  2004-07-23     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0370473     Medline TA:  Am J Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  39-44     Citation Subset:  AIM; IM    
Affiliation:
Laboratory of Gastrointestinal Motility, University Hospital of Heraklion, GR-711 10 Heraklion, Crete, Greece. chrysos@med.uoc.gr
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Esophagogastric Junction / physiopathology*
Female
Fundoplication / adverse effects*,  methods*
Gastroesophageal Reflux / physiopathology*,  surgery*
Humans
Male
Manometry
Middle Aged
Pressure
Statistics, Nonparametric

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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