An antireflux procedure for use with the reversed gastric tube

A study was undertaken to determine whether reflux could be reduced or prevented by creation of a nipple valve at the distal end of a reversed gastric tube. The gastric tube was constructed in standard fashion in six adult dogs. The tube was placed through a substernal tunnel to a cutaneous ostomy in the neck. An antireflux valve was then created by invaginating the lower end of the tube into the gastric remnant. The following observations were made before and after creation of the valve: (1) gastric distending pressure required to produce efflux of saline from the ostomy; (2) manometric pressure at the stomach-tube junction; and (3) 2-hour pH monitoring within the tube after acid infusion into the stomach. The valve shortened the gastric tube by 2.0 to 2.5 cm. It did not obstruct antegrade flow of saline. Prior to creation of the valve, reflux of saline out of the cutaneous ostomy occurred at an average pressure of 62 cm H2O (range 25 to 80). The antireflux procedure prevented reflux with distending pressures up to 200 cm H2O. Manometry revealed an average pressure of 18 cm H2O (range 5 to 25) at the lower end of the tube before creation of the valve. The antireflux procedure raised this high pressure zone to 60 cm H2O (Range 50 to 65) (P less than 0.05). Spontaneous reflux was rarely observed in the anesthetized dog when acid was infused into the stomach and the pH was monitored in the gastric tube. Acid reflux could easily be produced by application of minimal manual pressure to the closed abdomen.(ABSTRACT TRUNCATED AT 250 WORDS)