[Intravagal fundoplication and cardiofundal vagotomy: a technical physiologic variant in surgery of reflux]

In treating hyperacid gastro-esophageal reflux it is debatable whether or not to combine an antireflux operation with an antipeptic procedure. The problem is controversial as evidenced by the number of operative procedures and the diverse opinions in published reports. We believe that if there is an increased gastric acid secretion the combination of fundoplication and vagotomy is a logical alternative to long-term treatment with H2-receptor antagonists or with the new H+ protone blocker Omeprazol, especially when these conservative measures fail. The superselective vagotomy poses technical problems for it compromises the anchorage of the fundic wrap. On the other hand truncal vagotomy, though technically simpler, is unacceptable because of its associated side effects. As a result we have come to modify our standard technique. We combine a selective denervation of the esophago-gastric junction with a modification to our standard fundoplication procedure, whereby the fundic wrap is drawn forward between the vagal trunks and the lesser gastric curvature. In the last five years we have operated 58 patients in this combined way. We were able to carry out follow-up controls in 32 patients. All of them showed good long-term healing with improvement of reflux symptoms.