PROSPECTIVE-STUDY OF THE EFFECT OF THE BELSEY MARK-IV FUNDOPLICATION ON REFLUX MECHANISMS

Background: Transient lower esophageal sphincter relaxations (TLESRs) are the major mechanism permitting gastroesophageal reflux (GER). Litt le information is available on how anti-reflux surgery affects reflux mechanisms, especially TLESRs. We evaluated the effects of partial fun doplication (Belsey Mark IV) on reflux mechanisms. Methods: Sixteen pa tients were prospectively studied before and after Belsey Mark-IV oper ation by endoscopy, 24-h esophageal pH-metry, and simultaneous recordi ng of pH and lower esophageal sphincter (LES) characteristics by sleev e manometry. Results: The operation was successful in 14 of 16 patient s (87%). Fasting and postprandial reflux decreased significantly (P < 0.01) after the operation. Partial fundoplication significantly (P < 0 .05) decreased the number of TLESRs per hour in the fasting and postpr andial period from 3.2 +/- 0.4 and 5.6 +/- 0.5 to 1.7 +/- 0.3 and 2.8 +/- 0.4, respectively. The percentage of TLESRs associated with reflux also decreased significantly (P < 0.05). Basal LES pressure increased from 14.7 +/- 2.1 mmHg to 17.9 +/- 2.6 mmHg (not significant). Conclu sions: Partial fundoplication controls GER through a reduction in the number of TLESRs and by decreasing the number of relaxations associate d with reflux.