[Dynamic pexis (teresplasty) in the treatment of reflux esophagitis]

For teresplasty, the lig. teres has to be prepared together with a palmarsize patch of peritoneal layer to the effect that by suturing the edges of that peritoneal layer a solid cord is produced which is firmly connected to the liver via the lig. falciforme and lig. teres. The loose end of that cordlike structure is fixed by suturing between the distal part of the oesophagus and the gastric floor. The left lobe of the liver comes to lie on top of the ligament, and a permanent longitudinal tension is applied to the oesophagus via the liver. Necessary restressing is thus produced, as recommended by Stelzner for restoration of the lower oesophageal sphincter function. The effect is dilatory angiomuscular closure of the distal oesophagus. Evidence to the effectiveness of teresplasty has so far been produced from 48 patients with therapy-resistant oesophagitis and severe complaints. The approach proved to be superior to other surgical techniques to cope with reflux, in that, different from plication, no detrimental sequels were recordable (gas bloat syndrome, telescopic phenomenon).