[A schematic comparative study of four procedures for correcting gastroesophageal reflux by way of the abdomen...

After reviewing the physiopathology of the three principle antireflux mechanisms (hiatal orifice, valvular arrangement, inferior esophageal sphincter) the author arrives at six surgical criteria for the correction of gastroesophageal reflux. He makes, in regard to these different criteria, a critical study comparing two standard methods of esophagofundal wrapping (completely with the Nissen method, partially posteriorly according to the Toupet technic) with two more recent procedures of partitioning the esophagofundal component (one being calibrated transgastrically by the Rignault technic and the other from above after the method of the author). If the hiatal orifice is enlarged and if the phrenoesophageal membrane is stretched after correcting the hiatal orifice, the preferable operation is the partitionning one which gives a better correction and satisfies the other factors (a large fundus, an abdominal esophagus of 5-6 cms in length, side to side apposition of the esophagus and fundus, an inverted cone-shaped lower esophagus), on the condition that a selective calibration is effected in the new cardia (a diameter of 10-11 mm for the esophagogastric opening) overtopped by a reconstructed esophagus shaped like the mouth piece of a flute (a one way valve).