OBJECTIVES: This study compared the pressure topography after laparoscopic Nissen fundoplication to that of normal subjects and patients with hiatal hernia and reflux disease. METHODS: Seven patients with fundoplication, 7 normal subjects and 7 patients with hiatal hernia, were studied. The squamocolumnar junction and intragastric margin of the esophagogastric junction (EGJ) were marked with metal clips. Axial and radial characteristics of EGJ pressure were mapped relative to the hernia and clipped during concurrent fluoroscopy and manometry. Responses to inspiration and abdominal compression were also analyzed. RESULTS: Fundoplication modifies the EGJ by restoration of the hiatal component of EGJ pressure and elongation of the subdiaphragmatic component. Maximal EGJ pressure after fundoplication is mainly dependent on the extrinsic effect of the hiatal canal that compresses the esophagus; the resultant length of the EGJ reflects the length of the fundic wrap. Integrity of the EGJ after fundoplication is independent of the intrinsic lower esophageal sphincter itself. CONCLUSIONS: Fundoplication alters the pressure topography of the EGJ by reducing the hiatal hernia, tightening the hiatal orifice, and constructing a subdiaphragmatic wrap of variable length. Each effect depends on different technical aspects of the surgery with the potential of substantial variability in the resultant pressure topography.
OBJECTIVES: This study compared the pressure topography after laparoscopic Nissen fundoplication to that of normal subjects and patients with hiatal hernia and reflux disease. METHODS: Seven patients with fundoplication, 7 normal subjects and 7 patients with hiatal hernia, were studied. The squamocolumnar junction and intragastric margin of the esophagogastric junction (EGJ) were marked with metal clips. Axial and radial characteristics of EGJ pressure were mapped relative to the hernia and clipped during concurrent fluoroscopy and manometry. Responses to inspiration and abdominal compression were also analyzed. RESULTS: Fundoplication modifies the EGJ by restoration of the hiatal component of EGJ pressure and elongation of the subdiaphragmatic component. Maximal EGJ pressure after fundoplication is mainly dependent on the extrinsic effect of the hiatal canal that compresses the esophagus; the resultant length of the EGJ reflects the length of the fundic wrap. Integrity of the EGJ after fundoplication is independent of the intrinsic lower esophageal sphincter itself. CONCLUSIONS: Fundoplication alters the pressure topography of the EGJ by reducing the hiatal hernia, tightening the hiatal orifice, and constructing a subdiaphragmatic wrap of variable length. Each effect depends on different technical aspects of the surgery with the potential of substantial variability in the resultant pressure topography.
Authors: John E Pandolfino; Jennifer Curry; Guoxiang Shi; Raymond J Joehl; James G Brasseur; Peter J Kahrilas Journal: Ann Surg Date: 2005-07 Impact factor: 12.969
Authors: Matías Mihura Irribarra; Sandra Blitz; Candice L Wilshire; Anee Sophia Jackson; Alexander S Farivar; Ralph W Aye; Christy M Dunst; Brian E Louie Journal: J Gastrointest Surg Date: 2019-03-15 Impact factor: 3.452
Authors: Mikhail Attaar; Bailey Su; Harry Wong; Zachary Callahan; Kristine Kuchta; Stephen Stearns; John G Linn; Woody Denham; Stephen P Haggerty; Michael B Ujiki Journal: Surg Endosc Date: 2021-08-31 Impact factor: 3.453
Authors: Monika A Kwiatek; Kahrilas Kahrilas; Nathaniel J Soper; William J Bulsiewicz; Barry P McMahon; Hans Gregersen; John E Pandolfino Journal: J Gastrointest Surg Date: 2010-02 Impact factor: 3.452
Authors: Brian E Louie; Seema Kapur; Maurice Blitz; Alexander S Farivar; Eric Vallières; Ralph W Aye Journal: J Gastrointest Surg Date: 2012-11-27 Impact factor: 3.452