GASTROESOPHAGEAL REFLUX AND A COMPARISON OF THE DIFFERENT ANTIREFLUX PROCEDURES FOLLOWING ESOPHAGOMYOTOMY - AN EXPERIMENTAL-STUDY IN RABBITS

The surgical options for achalasia remain controversial regarding the surgical access route, whether it be transthoracic or transabdominal, the need of, and the type of an added antireflux procedure following a n esophagomyotomy. These questions were investigated in an experimenta l study that used 30 albino rabbits divided into six groups, as follow s: transabdominal Heller's esophagomyotomy (TAHE), transthoracic I-fel ler's esophagomyotomy (TTHE), TAHE and Nissen total fundoplication (NF ), TAHE and partial fundoplication (PF), TAHE and modified fundoplicat ion (MF), and a control group, Esophageal transit time (ETT) and gastr oesophageal reflux (GER) were evaluated by scintigraphy on the seventh postoperative day. When an esophagomyotomy was performed either with a transabdominal or transthoracic approach, a significantly increased GER rate was found in comparison to the controls. All types of antiref lux procedures performed prevented GER effectively. Although NF and PF groups showed a significant delay in ETT when compared to the control group (P < 0.001), no such finding was observed in the MF group. In c onclusion, an antireflux procedure following an esophagomyotomy is rec ommended, A modified fundoplication was thus found to be as effective as the other techniques in preventing GER, and was even a safer method when obstructive findings following a total or partial fundoplication were considered.