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. 1984 May;199(5):580–589. doi: 10.1097/00000658-198405000-00013

Surgical treatment of intractable esophagitis.

H B Gregorie Jr, R S Cathcart 3rd, R J Gregorie
PMCID: PMC1353496  PMID: 6721607

Abstract

An operative technique combining a 360-degree fundoplication which is stabilized by anchoring the gastroesophageal junction to the middle arcuate ligament was used in a series of 140 patients since 1973. The patients were evaluated 1 year or more after surgery with clinical and radiographic assessment, regardless of complaints. Clinical results have been good in 91%. There has been no operative mortality and minor transient morbidity. X-rays done at least 1 year after surgery were compared with results obtained in 88 patients who had a modification of Hill's posterior gastropexy performed during the earlier years of this experience. The incidence of x-ray abnormalities with the posterior gastropexy was reduced from 23.5% to 5% when fundoplication was used in combination with a posterior gastropexy. The anchorage of the esophagogastric junction to the middle arcuate ligament allows a relatively loose fundoplication and thereby has reduced the incidence of disabling gas-bloat. Stabilizing the fundoplication prevents the occurrence of other complications related to fundoplication such as disruption, migration, and obstruction. This technique avoids the use of sutures in the esophageal wall, thus reducing the potential for perforation, fistula, or injury to the vagus nerves.

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Selected References

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

  1. ALLISON P. R. Reflux esophagitis, sliding hiatal hernia, and the anatomy of repair. Surg Gynecol Obstet. 1951 Apr;92(4):419–431. [PubMed] [Google Scholar]
  2. Alday E. S., Goldsmith H. S. Efficacy of fundoplication in preventing gastric reflux. Am J Surg. 1973 Sep;126(3):322–324. doi: 10.1016/s0002-9610(73)80117-5. [DOI] [PubMed] [Google Scholar]
  3. Allison P. R. Hiatus hernia: (a 20-year retrospective survey). Ann Surg. 1973 Sep;178(3):273–276. doi: 10.1097/00000658-197309000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Barker J. R., Alexander-Williams J. The effect of cholecystectomy on oesophageal symptoms. Br J Surg. 1974 May;61(5):346–348. doi: 10.1002/bjs.1800610503. [DOI] [PubMed] [Google Scholar]
  5. Belsey R. H. Gastroesophageal reflux. Am J Surg. 1980 Jun;139(6):775–781. doi: 10.1016/0002-9610(80)90382-7. [DOI] [PubMed] [Google Scholar]
  6. Belsey R. Functional disease of the esophagus. J Thorac Cardiovasc Surg. 1966 Aug;52(2):164–188. [PubMed] [Google Scholar]
  7. Bremner C. G. Gastric ulceration after a fundoplication operation for gastroesophageal reflux. Surg Gynecol Obstet. 1979 Jan;148(1):62–64. [PubMed] [Google Scholar]
  8. Bushkin F. L., Neustein C. L., Parker T. H., Woodward E. R. Nissen fundoplication for reflux peptic esophagitis. Ann Surg. 1977 Jun;185(6):672–677. doi: 10.1097/00000658-197706000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Bushkin F. L., Neustein C. L., Parker T. H., Woodward E. R. Nissen fundoplication for reflux peptic esophagitis. Ann Surg. 1977 Jun;185(6):672–677. doi: 10.1097/00000658-197706000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. DeMeester T. R., Wernly J. A., Bryant G. H., Little A. G., Skinner D. B. Clinical and in vitro analysis of determinants of gastroesophageal competence. A study of the principles of antireflux surgery. Am J Surg. 1979 Jan;137(1):39–46. doi: 10.1016/0002-9610(79)90008-4. [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. Ellis F. H., Jr Controversies regarding the management of hiatus hernia. Am J Surg. 1980 Jun;139(6):782–788. doi: 10.1016/0002-9610(80)90383-9. [DOI] [PubMed] [Google Scholar]
  13. Herrington J. L., Jr, Meacham P. W., Hunter R. M. Gastric ulceration after fundic wrapping. Vagal nerve entrapment, a possible causative factor. Ann Surg. 1982 May;195(5):574–581. doi: 10.1097/00000658-198205000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Hill L. D., Tobias J., Morgan E. H. Newer concepts of the pathophysiology of hiatal hernia and esophagitis. Am J Surg. 1966 Jan;111(1):70–79. doi: 10.1016/0002-9610(66)90345-x. [DOI] [PubMed] [Google Scholar]
  15. Kaminski D. L., Codd J. E., Sigmund C. J. Evaluation of the use of the median arcuate ligament in fundoplication for reflux esophagitis. Am J Surg. 1977 Dec;134(6):724–729. doi: 10.1016/0002-9610(77)90311-7. [DOI] [PubMed] [Google Scholar]
  16. Maher J. W., Hollenbeck J. I., Woodward E. R. An analysis of recurrent esophagitis following posterior gastropexy. Ann Surg. 1978 Mar;187(3):227–230. doi: 10.1097/00000658-197803000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. NISSEN R. Gastropexy and "fundoplication" in surgical treatment of hiatal hernia. Am J Dig Dis. 1961 Oct;6:954–961. doi: 10.1007/BF02231426. [DOI] [PubMed] [Google Scholar]
  18. O'Sullivan G. C., DeMeester T. R., Joelsson B. E., Smith R. B., Blough R. R., Johnson L. F., Skinner D. B. Interaction of lower esophageal sphincter pressure and length of sphincter in the abdomen as determinants of gastroesophageal competence. Am J Surg. 1982 Jan;143(1):40–47. doi: 10.1016/0002-9610(82)90127-1. [DOI] [PubMed] [Google Scholar]
  19. 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]
  20. Polk H. C., Jr, Zeppa R. Hiatal hernia and esophagitis: a survey of indications for operation and technic and results of fundoplication. Ann Surg. 1971 May;173(5):775–781. doi: 10.1097/00000658-197105000-00017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Richardson J. D., Kuhns J. G., Richardson R. L., Polk H. C., Jr Properly conducted fundoplication reverses histologic evidence of esophagitis. Ann Surg. 1983 Jun;197(6):763–770. doi: 10.1097/00000658-198306000-00016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Richardson J. D., Larson G. M., Polk H. C., Jr Intrathoracic fundoplication for shortened esophagus. Treacherous solution to a challenging problem. Am J Surg. 1982 Jan;143(1):29–35. doi: 10.1016/0002-9610(82)90125-8. [DOI] [PubMed] [Google Scholar]
  23. Rogers D. M., Herrington J. L., Jr, Morton C. Incidental splenectomy associated with Nissen fundoplication. Ann Surg. 1980 Feb;191(2):153–156. doi: 10.1097/00000658-198002000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Saik R. P., Greenburg A. G., Peskin G. W. A study of fundoplication disruption and deformity. Am J Surg. 1977 Jul;134(1):19–24. doi: 10.1016/0002-9610(77)90278-1. [DOI] [PubMed] [Google Scholar]
  25. Thomas A. N., Hall A. D., Haddad J. K. Posterior gastropexy. Selection and management of patients with symptomatic hiatal hernia. Am J Surg. 1973 Aug;126(2):148–156. doi: 10.1016/s0002-9610(73)80146-1. [DOI] [PubMed] [Google Scholar]
  26. Urschel H. C., Jr, Paulson D. L. Gastroesophageal reflux and hiatal hernia. Complications and therapy. J Thorac Cardiovasc Surg. 1967 Jan;53(1):21–32. [PubMed] [Google Scholar]
  27. Vansant J. H., Baker J. W., Jr Complications of vagotomy in the treatment of hiatal hernia. Ann Surg. 1976 Jun;183(6):629–635. doi: 10.1097/00000658-197606000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Vansant J. H., Baker J. W., Ross D. G. Modification of the Hill technique for repair of hiatal hernia. Surg Gynecol Obstet. 1976 Oct;143(4):637–642. [PubMed] [Google Scholar]
  29. Woodward E. R. Surgical treatment of reflux peptic esophagitis. Am Surg. 1982 Dec;48(12):647–651. [PubMed] [Google Scholar]
  30. Woodward E. R., Thomas H. F., McAlhany J. C. Comparison of crural repair and Nissen fundoplication in the treatment of esophageal hiatus hernia with peptic esophagitis. Ann Surg. 1971 May;173(5):782–792. doi: 10.1097/00000658-197105000-00018. [DOI] [PMC free article] [PubMed] [Google Scholar]

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