Abstract
Although there are many studies evaluating the effect of elevated gastric pressure in total wrap and partial anterior and posterior wrap fundoplications, there are no ex vivo manometric studies evaluating the contribution of elevated gastric pressure to prevention of gastroesophageal reflux (GER) in Collis and uncut Collis procedures without fundoplication. An experimental study has been designed to determine the contribution of elevated intragastric pressure in the absence of in vivo anatomic and functional factors to the prevention of GER in Collis and uncut Collis without fundoplication procedures. The study was conducted on adult male New Zealand rabbits' esophagus and stomachs. The stomachs were divided into four groups: total wrap fundoplication group, partial wrap anterior fundoplication group, Collis without fundoplication group, and uncut Collis without fundoplication group. The minimum intragastric pressure (MIP) causing GER of each stomach before and after the procedure were measured with a two-way catheter introduced through the pylorus. The MIP values causing GER of the total wrap and partial anterior wrap fundoplication groups were found to be significantly higher compared with the basal intragastric pressures (P < 0.01). The MIP values causing GER of the Collis and uncut Collis without fundoplication groups were not significantly different compared with basal intragastric pressures (P > 0.05). The elevated gastric pressure is found to be insufficient to prevent GER in Collis and uncut Collis without fundoplication procedures. The efficacy of these procedures in preventing GER seems to be related to the anatomic and functional factors affecting in vivo circumstances.
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Boix-Ochoa J, Rowe MI: Gastroesophageal reflux. In Pediatric Surgery, 5th ed. O'Neill JA Jr, Rowe MI, Grosfeld JL, Fonkalsrud EW, Coran AG (eds). St. Louis, MO, Mosby, 1998, pp 1007–1028
Boix-Ochoa J, Marhuenda C: Gastroesophageal reflux. In Pediatric Surgery, 3rd ed. Ashcraft KW, Murphy JP, Sharp RJ, Sigalet DL, Snyder CL (eds). Philadelphia, PA, W. B. Saunders, 2000, pp 370–389
Cameron BH, Cochran WJ, McGill CW: The uncut Collis-Nissen fundoplication: results of 79 consecutively treated high-risk children. J Pediatr Surg 32:887–891, 1997
Taylor TV, Knox R, Pullan BR: Vertical gastric plication: An operation for gastro-esophageal reflux. Ann Roy Coll Surg Engl 71:31–36,1989
Mutaf O, Abasiyanik A, Karaca I, Arikan A, Mir E: Treatment of gastroesophageal reflux with a gastric tube cardioplasty. J Pediatr Surg 38:571–574, 2003
Kawahara H, Imura K, Yagi M, Yoneda A, Soh H, Tazuke Y, Okada A: Mechanisms underlying the antireflux effect of Nissen fundoplication in children. J Pediatr Surg 33:1618–1622, 1998
Rydberg L, Ruth M, Lundell L: Mechanism of action of antireflux procedures. Br J Surg: 86:405–410, 1999
Kawahara H, Nakajima K, Yagi M, Okuyama H, Kubota A, Okada A: Mechanisms responsible for reccurrent gastroesophageal reflux in neurologically impaired children who underwent laparoscopic Nissen fundoplication. Surg Endosc 16:767–771, 2002
Watson DI, Mathew G, Pike GK, Baigrie RJ, Jamieson GG: Efficacy of anterior, posterior and total fundoplication in an experimental model. Br J Surg 85:1006–1009, 1998
Yau P, Watson DI, Ascott N, Lafullarde T, Jamieson GG: Efficacy of 90 degree anterior fundoplication vs a total fundoplication in an experimental model. Surg Endosc 14:830–833, 2000
Watson DI, Mathew G, Pike GK, Jamieson GG: Comparison of anterior, posterior and total fundoplication using a viscera model. Dis Esophagus 10:110–114, 1997
Richardson WS, Trus. TL, Thompson S, Hunter JG: Nissen and Toupet fundoplications effectively inhibit gastroesophageal reflux irrespective of natural anatomy and function. Surg Endosc 11:261–263, 1997
Caniano DA, Ginn-Pease ME, King DR: The failed antireflux procedure: Analysis of risk factors and morbidity. J Pediatr Surg 25:1022–1026, 1990
Demos NJ: The stapled, uncut gastroplasty for hiatal hernia: 12 year followup. Ann Thorac Surg 38:393–399, 1984
Trastek VF: Uncut Collis-Nissen gastroplasty. Chest Surg Clin North Am 5:423–435, 1995
Hoffman MA, Stylianos S, Jacir SS: Technique of the transabdominal uncut Collis-Nissen fundoplication. Pediatr Surg Int 5:471–472, 1990
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Ateş, O., Hakgüder, G., Olguner, M. et al. The Contribution of Elevated Gastric Pressure to Prevention of Gastroesophageal Reflux in Several Different Antireflux Procedures. Dig Dis Sci 50, 2129–2133 (2005). https://doi.org/10.1007/s10620-005-3019-5
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DOI: https://doi.org/10.1007/s10620-005-3019-5