The total fundoplication gastroplasty: surgical procedure and radiologic appearance

The total fundoplication gastroplasty (TFG) consists of a combination of an esophagus-lengthening Collis gastroplasty and suturing of the gastric fundus to the esophagus and neo-esophagus to produce a stable intra-abdominal segment together with a complete Nissen fundoplication tailored in length to control reflux and avoid overcompetence. We studied 50 patients at least three months after TFG with an upper gastrointestinal examination and a tube esophagogram. Tube esophagography enhances distension of the esophagus and esophagogastric junction and eliminates the barium pool often seen in the distal esophagus in double-contrast esophagography. With this technique we were better able to understand the radiologic anatomy of the esophagogastric junction following TFG. Tube esophagography provided additional radiologic information in the five patients (10%) with preoperative peptic strictures of the esophagus. We describe the surgical and radiologic anatomy of the TFG, the technique of postoperative radiographic examination, and the postoperative problems we have encountered.