A new technique for preventing wrap disruption/migration after laparoscopic Nissen fundoplication: an experimental...

Laparoscopic Nissen fundoplication (LNF) is associated with a wrap disruption/migration rate of 3-40%. At reoperation, there is usually a lack of adhesions between the wrap, esophagus, and crura. In this paper, we report a new technique for the induction of scarring in the fundic wrap.

Eighteen pigs weighing 12-18 kg underwent LNF and were divided into three groups (n = 6 in each). In group A, sandpaper was used to accelerate adhesion formation between the right and left gastric fundi, as well as between the wrap and the crura, by rubbing the surfaces of the gastric fundi and the crura. In group B, fibrin glue was injected between the esophagus and the wrap. Group C received no treatment and acted as controls. All pigs were sacrificed 3 months later, and en bloc specimens consisting of the lower esophagus, fundic wrap, and diaphragmatic crura were examined for evidence of adhesions.

There was no wrap disruption or migration in any pig. In group A, there were dense adhesions visible macroscopically between the esophagus and the right and left fundi, and the wrap was adhered tightly to the crura. Microscopically, there were many collagen fibers between the esophagus and the wrap present. In groups B and C, macroscopic adhesions were absent or minimal between the esophagus and the wrap, and the wrap was less adhered to the crura. Histologically, the esophagus and both fundi were distinct with no fibers present between them.

Our results do not categorically prove that rubbing with sandpaper prevents wrap disruption or migration, but based on the assumption that denser adhesions hold tissues together more firmly, our technique might act to prevent wrap disruption or migration after LNF.