[Modifications of gastric distensibility as a function of the type of fundoplication. Experimental model in rats]

Gastric fundoplication to create an antireflux valve reduces gastric volume. The most widely used technique is Nissen's fundoplication (NF), but an anterior (AF) and posterior (PF) partial fundoplication are also used. This study examines the changes caused by these three techniques on the volume and the compliance of the stomach in vitro.

We used 4 groups of 10 rats Wistar each, weighing approximately 250-300 grams. One group was not manipulated (Control) whereas the other groups had NF, AF or PF respectively. The fresh stomachs were removed and progressively filled with saline by means of an infusion pump and the intragastric pressure was continuously measured with a pressure monitor. The volume of saline infusion required necessary to achieve pressure increments of 1 unit from 0 to 30 mmHg were measured and the results were compared with ANOVA.

The three modalities of fundoplication reduced significantly gastric compliance since rats from the control group required 21.7 +/- 3.3 mL to reach intragastric pressure of 30 mmHg whereas 9.5 +/- 2.4 mL, 11.75 +/- 1.8 mL and 13.4 +/- 2.2 mL were required for the groups NF, AF and PF respectively. According to these results, the type of fundoplication which reduced the least the compliance was the posterior one.

The use of fundus of the stomach to create an antireflux valve always implies a significant reduction of gastric compliance, which can favour gastric emptying and thus dumping syndrome. Even though important, this reduction was slightly less relevant after posterior fundoplication in this model. This evidence must be taken into account when choosing an antireflux technique.