Efficacy of a 90 degrees anterior fundoplication vs a total fundoplicationin an experimental model

Background: The surgical treatment of gastroesophageal reflux disease (GERD ) has improved greatly, so that excellent long-term control of symptoms can now be achieved. At present, the gold standard for treatment is the Nissen fundoplication. However, this procedure produces side effects in some pati ents, including persistent dysphagia, epigastric bloating, and excessive fl atulence. As a result, some surgeons who have recommended the use of a part ial fundoplication to lessen the occurrence of these side effects. The aim of this study was to determine the efficacy of a laparoscopically construct ed 90 degrees anterior fundoplication and to compare this method with the N issen fundoplication. Methods: Twelve domestic white pigs underwent initial esophageal myotomy to ensure an incompetent lower esophageal sphincter. These animals were then randomized to undergo either a total fundoplication or a 90 degrees wrap. A ll procedures were completed laparoscopically. Resting lower esophageal sph incter pressures were measured immediately and at 2 weeks postoperatively w ith a water-perfused esophageal manometry catheter incorporating a Dent sle eve. The efficacy of the antireflux barrier was determined at 2 weeks after surgery by fundoplication yield studies. Results: Both the total fundoplication and the 90 degrees wrap produced an increase in resting lower esophageal sphincter pressure and restored adequa te competence to the gastroesophageal junction in the early postoperative p eriod. Conclusion: A laparoscopically completed 90 degrees anterior fundoplication restores lower esophageal sphincter competence in the early postoperative period. Clinical studies examining the long-term results and significant si de effects of this procedure are required to establish the place for this p rocedure in the antireflux surgery armamentarium.