[Prevention of gastroesophageal reflux. Validity of hemifundoplication according to Cor-Casolo (experimental study)]

After a short preface about the main antireflux techniques employed in the treatment and prevention of gastro-oesophageal reflux, the problems involved in the iatrogenous gastro-oesophageal reflux are stated. As no unanimous opinion exists till now in literature about the importance and incidence of reflux after the operation of extramucous cardiomyotomy according to Heller, used in the treatment of achalasia, and after the Parietal Cell Vagotomy, employed in the treatment of duodenal ulcer, an experimental protocol was set up. An experimental research was performed on 16 dogs, subdivided into 3 groups: in the first group (6 dogs) extramucous cardiomyotomy according to Heller and antireflux procedure (antero-lateral hemifundoplication according to Dor-Casolo) were performed; in the second group (6 dogs) Parietal Cell Vagotomy + extramucous cardiomyotomy according to Heller + antero-lateral hemifundoplication according to Dor-Casolo were performed; in the third group (control) the only extramucous cardiomyotomy according to Heller was performed. In the research, articulated in two stages (1st time - operation; 2nd time - remote checking) the following was effected: pressure gauge test; pH-metric test; gastro-oesophageal scintigraphic test with Tc99m; histopathologic test. The experimental results obtained, elaborated by computer, demonstrated: that extramucous cardiomyotomy according to Heller causes serious oesophagitic phenomena, and therefore it should be joined to antireflux procedure; that Parietal Cell Vagotomy (P.C.V.) causes a significant decrease in the tone of L.E.S. (Lower Oesophageal Sphincter); that antero-lateral hemifundoplication according to Dor-Casolo (210 degrees) is effective in its antireflux action even after long time.