Surgical treatment of reflux peptic esophagitis

The lower esophageal sphincter is anatomically indistinct but physiologically active. Simultaneous pressure and pH measurements across the esophagogastric junction demonstrate loss of competence in patients with peptic esophagitis. Restoration to normal sphincter function is the objective of the surgeon. Experience is reported with three operations: 1) Crural repair with and without vagotomy and pyloroplasty (V & P); 2) Nissen fundoplication with and without V & P; and 3) Hill posterior gastropexy. The following conclusions were found. Crural repair is followed by recurrent esophagitis in 17 per cent and recurrent sliding hernia in 40 per cent. The Nissen procedure prevents recurrence of hernia and has recurrence of esophagitis in 4 per cent. Hill posterior gastropexy has a recurrence of about 12 per cent. Manometry shows a three-fold increase in resting LES pressure, correlating with sphincter competence. The "gas-bloat" syndrome after Nissen fundoplication is significant in 13 per cent. Vagotomy and pyloroplasty should not be used because of increased chronic morbidity.