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The effect of total and anterior partial fundoplication on antireflux mechanisms of the gastroesophageal junction
The effect of total (Nissen) and anterior partial fundoplication (APF) for the surgical treatment of gastroesophageal reflux disease (GERD) on the motor behavior of the esophagogastric axis has not been fully assessed. The purpose of this study was to assess any alterations in lower esophageal sphin...
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| Published in: | The American journal of surgery 2004-07, Vol.188 (1), p.39-44 |
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| container_title | The American journal of surgery |
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| creator | Chrysos, Emmanuel Athanasakis, Elias Pechlivanides, George Tzortzinis, Anastasios Mantides, Apostolos Xynos, Evaghelos |
| description | The effect of total (Nissen) and anterior partial fundoplication (APF) for the surgical treatment of gastroesophageal reflux disease (GERD) on the motor behavior of the esophagogastric axis has not been fully assessed. The purpose of this study was to assess any alterations in lower esophageal sphincter (LES) and gastric fundus motor parameters in GERD patients after Nissen or APF fundoplication.
Twenty four patients with documented GERD underwent either laparoscopic Nissen fundoplication (n = 12) or laparoscopic APF (n = 12). Preoperative and postoperative stationary esophageal manometry included assessment of LES resting and postdeglutition relaxation pressures, intragastric pressure, and LES transient relaxations in the left lateral and upright positions and after gastric distension.
Both types of fundoplication resulted in significant increases in LES resting (
P |
| doi_str_mv | 10.1016/j.amjsurg.2003.10.023 |
| format | article |
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Twenty four patients with documented GERD underwent either laparoscopic Nissen fundoplication (n = 12) or laparoscopic APF (n = 12). Preoperative and postoperative stationary esophageal manometry included assessment of LES resting and postdeglutition relaxation pressures, intragastric pressure, and LES transient relaxations in the left lateral and upright positions and after gastric distension.
Both types of fundoplication resulted in significant increases in LES resting (
P <0.001) and postdeglutition relaxation pressure (
P <0.001) in both positions and after gastric distention. Intragastric pressure increased only after Nissen fundoplication in the postgastric distention state (
P = 0.01). Transient LES relaxations were equally abolished after both procedures. All postoperative changes were to a similar level after either procedure with the exception of intragastric pressure after gastric distention, which was significantly higher after total than after partial fundoplication (
P = 0.04).
Both procedures equally increase LES resting and postdeglutition relaxation pressures and abolish transient LES relaxations at all states. The significantly higher intragastric pressure at the postgastric distention state after Nissen fundoplication could possibly explain the higher incidence of epigastric fullness and discomfort after this type of antireflux surgery.</description><identifier>ISSN: 0002-9610</identifier><identifier>EISSN: 1879-1883</identifier><identifier>DOI: 10.1016/j.amjsurg.2003.10.023</identifier><identifier>PMID: 15219483</identifier><identifier>CODEN: AJSUAB</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Digestive system ; Esophagogastric Junction - physiopathology ; Female ; Fundoplication - adverse effects ; Fundoplication - methods ; Gastroesophageal Reflux - physiopathology ; Gastroesophageal Reflux - surgery ; Gastroesophageal reflux disease ; Gastrointestinal diseases ; General aspects ; Health care ; Hernias ; Humans ; Lower esophageal sphincter pressure ; Male ; Manometry ; Medical sciences ; Middle Aged ; Nissen fundoplication ; Pressure ; Statistics, Nonparametric ; Surgery ; Throat ; Transient relaxations of lower esophageal pressure ; Watson anterior hemifundoplication</subject><ispartof>The American journal of surgery, 2004-07, Vol.188 (1), p.39-44</ispartof><rights>2004 Excerpta Medica Inc.</rights><rights>2004 INIST-CNRS</rights><rights>Copyright Elsevier Limited Jul 2004</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c447t-ed723db90964937432eabd1dadaca15e58a10ad64a7a2d20e72bbba3bdc2b8d83</citedby><cites>FETCH-LOGICAL-c447t-ed723db90964937432eabd1dadaca15e58a10ad64a7a2d20e72bbba3bdc2b8d83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=15911473$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15219483$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chrysos, Emmanuel</creatorcontrib><creatorcontrib>Athanasakis, Elias</creatorcontrib><creatorcontrib>Pechlivanides, George</creatorcontrib><creatorcontrib>Tzortzinis, Anastasios</creatorcontrib><creatorcontrib>Mantides, Apostolos</creatorcontrib><creatorcontrib>Xynos, Evaghelos</creatorcontrib><title>The effect of total and anterior partial fundoplication on antireflux mechanisms of the gastroesophageal junction</title><title>The American journal of surgery</title><addtitle>Am J Surg</addtitle><description>The effect of total (Nissen) and anterior partial fundoplication (APF) for the surgical treatment of gastroesophageal reflux disease (GERD) on the motor behavior of the esophagogastric axis has not been fully assessed. The purpose of this study was to assess any alterations in lower esophageal sphincter (LES) and gastric fundus motor parameters in GERD patients after Nissen or APF fundoplication.
Twenty four patients with documented GERD underwent either laparoscopic Nissen fundoplication (n = 12) or laparoscopic APF (n = 12). Preoperative and postoperative stationary esophageal manometry included assessment of LES resting and postdeglutition relaxation pressures, intragastric pressure, and LES transient relaxations in the left lateral and upright positions and after gastric distension.
Both types of fundoplication resulted in significant increases in LES resting (
P <0.001) and postdeglutition relaxation pressure (
P <0.001) in both positions and after gastric distention. Intragastric pressure increased only after Nissen fundoplication in the postgastric distention state (
P = 0.01). Transient LES relaxations were equally abolished after both procedures. All postoperative changes were to a similar level after either procedure with the exception of intragastric pressure after gastric distention, which was significantly higher after total than after partial fundoplication (
P = 0.04).
Both procedures equally increase LES resting and postdeglutition relaxation pressures and abolish transient LES relaxations at all states. The significantly higher intragastric pressure at the postgastric distention state after Nissen fundoplication could possibly explain the higher incidence of epigastric fullness and discomfort after this type of antireflux surgery.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Digestive system</subject><subject>Esophagogastric Junction - physiopathology</subject><subject>Female</subject><subject>Fundoplication - adverse effects</subject><subject>Fundoplication - methods</subject><subject>Gastroesophageal Reflux - physiopathology</subject><subject>Gastroesophageal Reflux - surgery</subject><subject>Gastroesophageal reflux disease</subject><subject>Gastrointestinal diseases</subject><subject>General aspects</subject><subject>Health care</subject><subject>Hernias</subject><subject>Humans</subject><subject>Lower esophageal sphincter pressure</subject><subject>Male</subject><subject>Manometry</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Nissen fundoplication</subject><subject>Pressure</subject><subject>Statistics, Nonparametric</subject><subject>Surgery</subject><subject>Throat</subject><subject>Transient relaxations of lower esophageal pressure</subject><subject>Watson anterior hemifundoplication</subject><issn>0002-9610</issn><issn>1879-1883</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><recordid>eNqFkd2L1DAUxYMo7jj6JygFcd865qsfeRJZ_IIFX9bncJvczqS0zWySyvrfmzoFxQeFhJDL7xwu5xDyktEDo6x-OxxgGuISjgdOqcizA-XiEdmxtlEla1vxmOwopbxUNaNX5FmMQ_4yJsVTcsUqzpRsxY7c352wwL5HkwrfF8knGAuYbb4Jg_OhOENILg_7Zbb-PDoDyfm5yCcjLmA_Lg_FhOYEs4tT_OWSPY8QU_AY_fkER8z6YZnNqnxOnvQwRnyxvXvy7eOHu5vP5e3XT19u3t-WRsomlWgbLmynqKqlEo0UHKGzzIIFA6zCqgVGwdYSGuCWU2x413UgOmt419pW7Mn1xfcc_P2CMenJRYPjCDP6Jeq6rivFcnZ78vovcPBLmPNumkkp6xymFP-kqGBMKZ4L2JPqQpngY8zh6HNwE4QfGdJrb3rQW2967W0dZ1nWvdrcl25C-1u1FZWBNxsA0cDYB5iNi39wKlfbrNy7C4c52u8Og47G4WzQ5qpM0ta7_6zyE1WXuo0</recordid><startdate>20040701</startdate><enddate>20040701</enddate><creator>Chrysos, Emmanuel</creator><creator>Athanasakis, Elias</creator><creator>Pechlivanides, George</creator><creator>Tzortzinis, Anastasios</creator><creator>Mantides, Apostolos</creator><creator>Xynos, Evaghelos</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20040701</creationdate><title>The effect of total and anterior partial fundoplication on antireflux mechanisms of the gastroesophageal junction</title><author>Chrysos, Emmanuel ; 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The purpose of this study was to assess any alterations in lower esophageal sphincter (LES) and gastric fundus motor parameters in GERD patients after Nissen or APF fundoplication.
Twenty four patients with documented GERD underwent either laparoscopic Nissen fundoplication (n = 12) or laparoscopic APF (n = 12). Preoperative and postoperative stationary esophageal manometry included assessment of LES resting and postdeglutition relaxation pressures, intragastric pressure, and LES transient relaxations in the left lateral and upright positions and after gastric distension.
Both types of fundoplication resulted in significant increases in LES resting (
P <0.001) and postdeglutition relaxation pressure (
P <0.001) in both positions and after gastric distention. Intragastric pressure increased only after Nissen fundoplication in the postgastric distention state (
P = 0.01). Transient LES relaxations were equally abolished after both procedures. All postoperative changes were to a similar level after either procedure with the exception of intragastric pressure after gastric distention, which was significantly higher after total than after partial fundoplication (
P = 0.04).
Both procedures equally increase LES resting and postdeglutition relaxation pressures and abolish transient LES relaxations at all states. The significantly higher intragastric pressure at the postgastric distention state after Nissen fundoplication could possibly explain the higher incidence of epigastric fullness and discomfort after this type of antireflux surgery.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>15219483</pmid><doi>10.1016/j.amjsurg.2003.10.023</doi><tpages>6</tpages></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Biological and medical sciences Digestive system Esophagogastric Junction - physiopathology Female Fundoplication - adverse effects Fundoplication - methods Gastroesophageal Reflux - physiopathology Gastroesophageal Reflux - surgery Gastroesophageal reflux disease Gastrointestinal diseases General aspects Health care Hernias Humans Lower esophageal sphincter pressure Male Manometry Medical sciences Middle Aged Nissen fundoplication Pressure Statistics, Nonparametric Surgery Throat Transient relaxations of lower esophageal pressure Watson anterior hemifundoplication |
| title | The effect of total and anterior partial fundoplication on antireflux mechanisms of the gastroesophageal junction |
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