Evaluation of posterior gastropexy for gastroesophageal reflux

The efficacy of posterior gastropexy as an antireflux procedure and its mechanism of action were studied by manometry and cinefluorography in a canine model. Gastroesophageal incompetence was produced in 13 dogs by dividing the vagi below the diaphragm and displacing the gastroesophageal junction into the chest. Reflux was associated with a decrease in the lower esophageal sphincter (LES) pressure measurements and in its response to abdominal compression. Posterior gastropexy done in seven dogs, improved both the resting and compression pressures in the LES, increased the length of the LES, and corrected reflux in five dogs. Replacement of the LES in the abdomen and crural (Allison) repair resulted in a similar increase in LES pressures and restored competence in four of the six animals. Neither procedure was able to restore the LES response to abdominal compression. Posterior gastropexy, like Allison repair, improves LES function by replacing it below the diaphragm, but does not produce a new valve.