Background: The "floppy" 360o esophagogastric fundoplication (EF) is an extremely effective operation for controlling gastroesophageal reflux. Dysphagia (DYS), however, remains a disturbing postoperative complication with long-term rates as high as 15%. It is our feeling that by further calibrating and thereby standardizing EF, the incidence of DYS may be reduced. "Wrap tension" (WT) describes the tension within the fundoplication itself during typical size calibration. The potential for this method of calibration is explored.
Methods: Using a porcine model 6 animals (50-58lbs) underwent celiotomy and multidiameter EF around an intraluminal 32F esophageal dilator (ED) equipped with a standard 4 channel manometry catheter. Each animal served as its own control. A 2cm EF was performed under repeatable geometric contstraints, with a fixed point and a variable point on the fundus. Ten minutes were allowed for stabilization of compliance of the esophageal wall prior to manometric measurements. This was followed by 10 readings at 30 sec intervals at each geometrically measured EF.
Results: Although the weights of the animals were similar, there were anatomical differences in fundic size which excluded 4 animals from the 8cm circumference fundoplication. Graphical data are reported as means +/- SEM. The difference in the means (student's t-test) between the 4cm-5cm and the 6cm-7cm fundoplication were statistically significant(p<0.001-p<0.03),differentiating the tight from the loose fundoplication.
Conclusions: WT is easily measurable and not dependent on anatomic variables. We propose that an ED combined with intraluminal manometry will allow a more physiologic and objective parameter in the calibration of EF.
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