[An experimental study on post-operative anti-reflux effect by modified Mark IV operation to esophageal achalasia]

This study was intended to specify the most appropriate procedure of myotomy and fundoplication in the modified Belsey Mark IV operation toward the esophageal achalasia to prevent post-operative refluxes. Adult mongrel dogs were prepared under surgical operation of, short myotomy, short fundoplication, long myotomy, long fundoplication, long myotomy, long fundoplication of artificial hiatus hernia type control. After the well recovery, they were examined on their simultaneous evaluation of pH and inner pressure at three points, i.e. the esophagus, the high pressure zone (HPZ), and the stomach. At the same time, withdrawal pH curves, etc. were also determined. The discussion resulted that the group of short myotomy, short fundoplication and the group of artificial hiatus hernia type long myotomy, long fundoplication were significantly superior to the group of long myotomy, long fundoplication. As the consequence of the experiment, firstly, the possibility that the surgical operation of long myotomy, long fundoplication causes hypertension of the intrathoracic esophagus, which resulted in the dysfunction of the anti-reflux mechanism of the valves was suggested. Secondly, it has been revealed that this dysfunction did not occur in the surgical operations on the length of HPZ. And thirdly, when the conventional Mark IV operation, which buries all the portions of the fundoplication under the diaphragm, causes hypertension to the intrathoracic esophagus, the surgical operation of artificial hiatus hernia type shall be applied to herniate the upper portion of the fundoplication to the thoracic cavity.