Experimental fundoplication: comparison of results of different techniques

After the creation of a hypotensive lower esophageal sphincter (LES) by circular myectomy, several techniques of fundoplication were employed to assess the effect of variations in the degree and length of fundoesophageal encirclement on LES function. In series A, 360 degrees wraps were constructed around varying lengths of esophagus: group I, 1 cm; group II, 2 cm; and group III, 3 cm. In series B, 2 cm long fundoplications of varying circumference were performed: group I, 90 degrees; group II, 180 degrees; and group III, 360 degrees. LES evaluation included measurement of LES amplitude and length, the adaptive response of the LES to increased intragastric pressure, pH reflux testing, and LES response to parenterally administered pentagastrin. In series A, 2 and 3 cm wraps restored resting LES pressures to normal (18.8 +/- 0.5 and 20.7 +/- 0.3 cm H2O) in contrast to the 1 cm wrap (12.9 +/- 0.8 cm H2O), and both provided more effective protection against reflux when compared to the shorter variation (pH, 6.2 +/- 0.1 and 6.6 +/- 0.1 versus 4.2 +/- 0.1). In series B, the 360 degrees wrap proved to be more effective than partially encircling techniques. Fundoplication optimally restores normal LES function when it encircles the esophagus completely over a length equivalent to the normal high-pressure zone (1.8 +/- 0.1 cm in the cat).