Skip to main content
NCBI home page
Annals of Surgery logoLink to Annals of Surgery
. 1981 May;193(5):655–665. doi: 10.1097/00000658-198105000-00017

Supradiaphragmatic correction of esophageal reflux strictures.

T C Pennell
PMCID: PMC1345142  PMID: 7235769

Abstract

Intragastric pressure measurements and cineradiographic contrast studies were done in monkeys in order to determine the pressure at which esophageal reflux occurred. Antireflux operative procedures were performed above and below the diaphragm, and the results compared. The Nissen fundoplication proved to be the most effective type of mechanical antireflux valve and worked equally well placed above and below the diaphragm. Of 200 consecutive adult patients undergoing operative correction of esophageal reflux, 19 had severe esophageal strictures. Through a transthoracic approach, two patients had subdiaphragmatic Nissen fundoplications, one with adenocarcinoma of the esophagus had an esophageal resection, and 16 had supradiaphragmatic Nissen fundoplications; those 16 patients form the basis of this report. No patients died; superficial, temporary esophageal ulcerations developed in two. Follow-up times have ranged from six months to eight years; the results in all cases have been good. Experimental and clinical evidence supports the belief that this less radical approach is the treatment of choice in the management of severe esophageal strictures secondary to reflux esophagitis.

Full text

PDF
655

Images in this article

657Fig. 1.
on p.657
657Fig. 2.
on p.657
658Figs. 3. and 4.
on p.658
659Figs. 5-7.
on p.659
660Figs. 8. and 9.
on p.660
660Fig. 10.
on p.660
661Figs. 11. and 12.
on p.661

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Balison J. R., Macgregor A. M., Woodward E. R. Postoperative diaphragmatic herniation following transthoracic fundoplication. A note of warning. Arch Surg. 1973 Feb;106(2):164–166. doi: 10.1001/archsurg.1973.01350140030010. [DOI] [PubMed] [Google Scholar]
  2. Belsey R. Mark IV repair of hiatal hernia by the transthoracic approach. World J Surg. 1977 Jul;1(4):475–481. doi: 10.1007/BF01565916. [DOI] [PubMed] [Google Scholar]
  3. Benedict E. B. Peptic stenosis of the esophagus. A study of 233 patients treated with bougienage, surgery, or both. Am J Dig Dis. 1966 Oct;11(10):761–770. doi: 10.1007/BF02233836. [DOI] [PubMed] [Google Scholar]
  4. Brand D. L., Ylvisaker J. T., Gelfand M., Pope C. E., 2nd Regression of columnar esophageal (Barrett's) epithelium after anti-reflux surgery. N Engl J Med. 1980 Apr 10;302(15):844–848. doi: 10.1056/NEJM198004103021506. [DOI] [PubMed] [Google Scholar]
  5. Brindley G. V., Jr, Wangsanutr L. Surgical treatment of stricture of the esophagus associated with hiatal hernia. Ann Surg. 1971 May;173(5):649–656. doi: 10.1097/00000658-197105000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Bushkin F. L., Woodward E. R., O'Leary J. P. Occurrence of gastric ulcer after Nissen fundoplication. Am Surg. 1976 Nov;42(11):821–826. [PubMed] [Google Scholar]
  7. Butterfield W. C. Current hiatal hernia repairs: similarities, mechanisms, and extended indications--an autopsy study. Surgery. 1971 Jun;69(6):910–916. [PubMed] [Google Scholar]
  8. CODE C. F., KELLEY M. L., Jr, SCHLEGEL J. F., OLSEN A. M. Detection of hiatal hernia during esophageal motility tests. Gastroenterology. 1962 Nov;43:521–531. [PubMed] [Google Scholar]
  9. COLLIS J. L. An operation for hiatus hernia with short esophagus. J Thorac Surg. 1957 Dec;34(6):768–778. [PubMed] [Google Scholar]
  10. Cohen S., Harris L. D. Does hiatus hernia affect competence of the gastroesophageal sphincter? N Engl J Med. 1971 May 13;284(19):1053–1056. doi: 10.1056/NEJM197105132841902. [DOI] [PubMed] [Google Scholar]
  11. Demeester T. R., Johnson L. F., Kent A. H. Evaluation of current operations for the prevention of gastroesophageal reflux. Ann Surg. 1974 Oct;180(4):511–525. doi: 10.1097/00000658-197410000-00016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Donahue P. E., Larson G. M., Stewardson R. H., Bombeck C. T. Floppy Nissen fundoplication. Rev Surg. 1977 Jul-Aug;34(4):223–224. [PubMed] [Google Scholar]
  13. Ellis F. H., Jr, Leonardi H. K., Dabuzhsky L., Crozier R. E. Surgery for short esophagus with stricture: an experimental and clinical manometric study. Ann Surg. 1978 Sep;188(3):341–350. doi: 10.1097/00000658-197809000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. HAYWARD J. The treatment of fibrous stricture of the oesophagus associated with hiatal hernia. Thorax. 1961 Mar;16:45–55. [PMC free article] [PubMed] [Google Scholar]
  15. Harrison G. K., Gompels B. M. Treatment of reflux strictures of the oesophagus by the Nissen-Rossetti operation. Thorax. 1971 Jan;26(1):77–80. doi: 10.1136/thx.26.1.77. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Heimlich H. J. Esophagoplasty with reversed gastric tube. Review of fifty-three cases. Am J Surg. 1972 Jan;123(1):80–92. doi: 10.1016/0002-9610(72)90315-7. [DOI] [PubMed] [Google Scholar]
  17. Henderson R. D. Reflux control following gastroplasty. Ann Thorac Surg. 1977 Sep;24(3):206–214. doi: 10.1016/s0003-4975(10)63744-7. [DOI] [PubMed] [Google Scholar]
  18. Herrington J. L., Jr, Wright R. S., Edwards W. H., Sawyers J. L. Conservative surgical treatment of reflux esophagitis and esophageal stricture. Ann Surg. 1975 May;181(5):552–566. doi: 10.1097/00000658-197505000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Hill L. D. An effective operation for hiatal hernia: an eight year appraisal. Ann Surg. 1967 Oct;166(4):681–692. doi: 10.1097/00000658-196710000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Hill L. D., Gelfand M., Bauermeister D. Simplified management of reflux esophagitis with stricture. Ann Surg. 1970 Oct;172(4):638–651. doi: 10.1097/00000658-197010000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Hollenbeck J. I., Woodward E. R. Treatment of peptic esophageal stricture with combined fundic patch-fundoplication. Ann Surg. 1975 Oct;182(4):472–477. doi: 10.1097/00000658-197510000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Jones E. L., Booth D. J., Cameron J. L., Zuidema G. D., Skinner D. B. Functional evaluation of esophageal reconstructions. Ann Thorac Surg. 1971 Oct;12(4):331–346. doi: 10.1016/s0003-4975(10)65135-1. [DOI] [PubMed] [Google Scholar]
  23. Karas L. M., Stern H., Bloom D., Binder H. J., Poindexter R., Thayer W., Spiro H. M. The gastroesophageal junction in the monkey and its relation to reflux. J Surg Res. 1966 Nov;6(11):469–477. doi: 10.1016/s0022-4804(66)80001-x. [DOI] [PubMed] [Google Scholar]
  24. Larrain A., Csendes A., Pope C. E., 2nd Surgical correction of reflux. An effective therapy for esophageal strictures. Gastroenterology. 1975 Sep;69(3):578–583. [PubMed] [Google Scholar]
  25. Leonardi H. K., Lee M. E., El-Kurd M. F., Ellis F. H., Jr An experimental study of the effectiveness of various antireflux operations. Ann Thorac Surg. 1977 Sep;24(3):215–222. doi: 10.1016/s0003-4975(10)63745-9. [DOI] [PubMed] [Google Scholar]
  26. MERENDINO K. A., DILLARD D. H. The concept of sphincter substitution by an interposed jejunal segment for anatomic and physiologic abnormalities at the esophagogastric junction; with special reference to reflux esophagitis, cardiospasm and esophageal varices. Ann Surg. 1955 Sep;142(3):486–506. doi: 10.1097/00000658-195509000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Moossa A. R., Cooley G. R., Skinner D. B. Intraluminal and intraperitoneal pressures at the cardia: effect of hormones and surgical intervention. Surg Forum. 1973;24:370–372. [PubMed] [Google Scholar]
  28. Murray G. F., Williams L. E., Wilcox B. R., Starek P. J. Management of reflux esophagitis with stricture. N C Med J. 1975 Dec;36(12):729–730. [PubMed] [Google Scholar]
  29. NAGLER R., SPIRO H. M. Segmental response of the inferior esophageal sphincter to elevated intragastric pressure. Gastroenterology. 1961 Mar;40:405–407. [PubMed] [Google Scholar]
  30. Naef A. P., Savary M. Conservative operations for peptic esophagitis with stenosis in columnar-lined lower esophagus. Ann Thorac Surg. 1972 Jun;13(6):543–551. doi: 10.1016/s0003-4975(10)65171-5. [DOI] [PubMed] [Google Scholar]
  31. Naef A. P., Savary M., Ozzello L. Columnar-lined lower esophagus: an acquired lesion with malignant predisposition. Report on 140 cases of Barrett's esophagus with 12 adenocarcinomas. J Thorac Cardiovasc Surg. 1975 Nov;70(5):826–835. [PubMed] [Google Scholar]
  32. Paulson D. L. Benign stricture of the esophagus secondary to gastroesophageal reflux. Ann Surg. 1967 May;165(5):765–779. doi: 10.1097/00000658-196705000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Pearson F. G., Langer B., Henderson R. D. Gastroplasty and Belsey hiatus hernia repair. An operation for the management of peptic stricture with acquired short esophagus. J Thorac Cardiovasc Surg. 1971 Jan;61(1):50–63. [PubMed] [Google Scholar]
  34. Pearson F. G. Surgical management of acquired short esophagus with dilatable peptic stricture. World J Surg. 1977 Jul;1(4):463–472. doi: 10.1007/BF01565913. [DOI] [PubMed] [Google Scholar]
  35. Polk H. C., Jr Fundoplication for reflux esophagitis: misadventures with the operation of choice. Ann Surg. 1976 Jun;183(6):645–652. doi: 10.1097/00000658-197606000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Safaie-Shirazi S., Zike W. L., Mason E. E. Esophageal stricture secondary to reflux esophagitis. Arch Surg. 1975 May;110(5):629–631. doi: 10.1001/archsurg.1975.01360110175029. [DOI] [PubMed] [Google Scholar]
  37. Skinner D. B., Belsey R. H. Surgical management of esophageal reflux and hiatus hernia. Long-term results with 1,030 patients. J Thorac Cardiovasc Surg. 1967 Jan;53(1):33–54. [PubMed] [Google Scholar]
  38. Skinner D. B. Complications of surgery for gastroesophageal reflux. World J Surg. 1977 Jul;1(4):485–490. doi: 10.1007/BF01565918. [DOI] [PubMed] [Google Scholar]
  39. THAL A. P., HATAFUKU T., KURTZMAN R. NEW OPERATION FOR DISTAL ESOPHAGEAL STRICTURE. Arch Surg. 1965 Apr;90:464–472. doi: 10.1001/archsurg.1965.01320100008003. [DOI] [PubMed] [Google Scholar]
  40. Thomas H. F., Clarke J. M., Rayl J. E., Woodward E. R. Results of the combined fundic patch-fundoplication operation in the treatment of reflux esophagitis with stricture. Surg Gynecol Obstet. 1972 Aug;135(2):241–245. [PubMed] [Google Scholar]
  41. Vansant J. H. Surgical management of hiatal hernia with esophageal reflux. Am Surg. 1978 Apr;44(4):179–195. [PubMed] [Google Scholar]
  42. WINSHIP D. H., POINDEXTER R. E., THAYER W. R., Jr, SPIRO H. M. ESOPHAGEAL MOTILITY IN THE MONKEY. Gastroenterology. 1965 Feb;48:231–236. [PubMed] [Google Scholar]
  43. Williamson R. C. The management of peptic oesophageal stricture. Br J Surg. 1975 Jun;62(6):448–454. doi: 10.1002/bjs.1800620607. [DOI] [PubMed] [Google Scholar]
  44. Woodward E. R. Surgical control of gastroesophageal reflux. Ann Thorac Surg. 1977 Sep;24(3):201–201. doi: 10.1016/s0003-4975(10)63741-1. [DOI] [PubMed] [Google Scholar]
  45. Woodward E. R. Surgical treatment of gastroesophageal reflux and its complications. World J Surg. 1977 Jul;1(4):453–460. doi: 10.1007/BF01565911. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES