Fundoplications resist reflux independent of in vivo anatomic relationships

BACKGROUND: Antireflux operations restore lower esophageal sphincter (LES) function and hiatal anatomy; however, the relative contributions ave unclea r. METHODS: We measured the competency of fundoplications, exclusive of in viv o variables, in gastroesophageal explants from 8 cadavers. Using a multicha nnel manometer, esophageal, LES, and intragastric pressures were recorded d uring transpyloric distension. Data were compared at baseline, and after Ni ssen (360 degrees) and Toupet (270 degrees) fundoplications. RESULTS: Before fundoplication, stomachs refluxed immediately upon distensi on. Nissen fundoplications never refluxed before gastric rupture (46.8 +/- 15.0 mm Hg). LES pressure averaged 2.0 +/- 0.5 times intragastric pressure during distension. Toupet fundoplications refluxed at intragastric pressure <2 mm Hg, then became competent until gastric rupture (49.9 +/- 15.0 mm Hg ). LES pressure averaged 2.4 +/- 1.0 times intragastric pressure during dis tension. CONCLUSIONS: Nissen and Toupet fundoplications increase LES pressure linear ly at 2 to 2.5 times intragastric pressure, independent of in vivo variable s. Toupet fundoplication lacks the competency of Nissen fundoplication at l ow intragastric pressures. (C) 1999 by Excerpta Medica, Inc.