Esophagogastric junction pressure topography after fundoplication

Area of Science:

• Gastroenterology
• Surgical Science
• Medical Imaging

Background:

• Gastroesophageal reflux disease (GERD) and hiatal hernias are common conditions.
• Laparoscopic Nissen fundoplication is a surgical procedure to treat GERD.
• Understanding the impact of fundoplication on esophageal pressure topography is crucial for surgical outcomes.

Purpose of the Study:

• To compare the pressure topography of the esophagogastric junction (EGJ) after laparoscopic Nissen fundoplication.
• To evaluate EGJ pressure characteristics in normal subjects and patients with hiatal hernia and reflux disease.

Main Methods:

• Studied 7 patients post-fundoplication, 7 normal subjects, and 7 with hiatal hernia.
• Utilized metal clips to mark the squamocolumnar junction and intragastric margin.
• Mapped EGJ pressure characteristics using concurrent fluoroscopy and manometry, analyzing responses to inspiration and abdominal compression.

Main Results:

• Fundoplication restores the hiatal component of EGJ pressure and elongates the subdiaphragmatic component.
• Maximal EGJ pressure is influenced by the hiatal canal's compression, with EGJ length reflecting the fundic wrap length.
• EGJ integrity after fundoplication is independent of the intrinsic lower esophageal sphincter.

Conclusions:

• Fundoplication modifies EGJ pressure topography by reducing hiatal hernias and tightening the hiatal orifice.
• The construction of a subdiaphragmatic wrap of variable length is a key outcome.
• Surgical technique significantly impacts the resultant pressure topography, leading to potential variability.