DISRUPTION OF EXPERIMENTAL FUNDIC FOLDS IS PREVENTED BY INTERSEROSAL SCARRING

Background The main cause of recurrent reflux symptoms after Nissen fu ndoplication is disruption of the fundic wrap. Reoperation has shown a lack of scar tissue between the serosal surfaces of the fundic folds in these cases. Methods Attempts were made to induce serosal scarring during fundoplication performed in rabbits. In group 1 the serosal fol ds were attached to the upper fundus with three non-absorbable seromus cular sutures. In group 2 Teflon pledgets were placed between these su tures. Fibrin glue was injected between the folds in group 3 and polyg lycolic acid mesh was inserted in group 4. Results When the rabbits we re killed 6 months later, the serosa had unfolded and no macroscopic o r microscopic scar tissue was found between the serosal surfaces, exce pt in five of the six rabbits in group 3, in which fibronectin, lamini n and collagen types I and III were present in interserosal scar tissu e. Conclusion Application of fibrin glue between the serosal surfaces of the fundic folds may prevent disruption of Nissen fundoplication.