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Background and Aims:Gastroesophageal reflux disease (GERD) is one of the most common dysfunctions of the upper GI. It is interfering with the quality of life and is a risk factor in development of adenocarcinoma of the lower esophagus. Laparoscopic fundoplication is an effective treatment in GERD but the physiological mechanisms of the different available procedures had yet to be investigated.Methods:28 German Landrace pigs underwent baseline manometry and 24h pH-monitoring followed by myotomy to induce a refluxesophagitis. After proving the new-onset reflux, the pigs were randomized to 4 Groups (total fundoplication, anterior hemifundoplication, posterior hemifundoplication and controls). On day 10 and 60 after the intervention, the effectiveness of the different modifications of fundoplication was compared with the controls by 24h pH-monitoring, manometry and after pharmacological stimulation. Finally the pigs were sacrificed and the Yield Volume and Pressure were recorded.ResultsAfter myotomy a significant increase of the reflux could be confirmed. After fundoplication we found a significant decrease of the fraction time (pH<4) and increase of the vector volume compared to measurement after myotomy. Total fundoplication and posterior hemifundoplication were highly effective while measurements after anterior fundoplication still revealed increased fraction times. Pharmacological stimulation with pentagastrin showed a significant increase of the Vector Volume due to contraction of the esophageal sphincter ConclusionTotal fundoplication and posterior hemifundoplication are potent operations for GERD. The anterior hemifundoplication reduces the reflux as well, but the effects were significantly lower compared to total and posterior fundoplication. Pharmacological stimulation revealed excellent results after posterior hemifundoplication and the tending to overcorrection after total fundoplication.