Vertical gastric plication: an operation for gastro-oesophageal reflux

An operation has been devised to prevent gastro-oesophageal reflux in which a vertical partition is made parallel to the proximal gastric lesser curvature. The technique, which can be simply, safely and rapidly performed, prevents reflux in the following ways: 1. Increasing the effective length of the 'intra-abdominal oesophagus'; 2. Increasing the crural sling and mucosal flap valve effect; 3. Sharpening the angle of entry into the gastric reservoir; 4. Creating a flutter valve and markedly reducing the gastric cross-sectional area along which reflux can occur. The stomach is neither opened nor divided. The efficacy of the operation was investigated in six dogs which had their lower oesophageal sphincter excised by circular myomectomy before vertical gastric plication. Pre- and postoperative manometric and oesophageal pH studies were performed. Vertical gastric plication prevented the oesophagitis produced by circular myomectomy alone. The operation has been performed in 26 patients over a 2-year period. Assessment has been by clinical methods, ambulatory 24 h pH studies and endoscopy. Twenty-one patients were classified in Visick grades I and II and ambulatory pH recordings showed a marked reduction in reflux in 13 of 14 patients. The operation is technically simple, quick and safe to perform, being accurately and scientifically reproducible.