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Ann Thorac Surg 1982;33:540-548
© 1982 The Society of Thoracic Surgeons

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Articles

Gastroplasty with Partial or Total Plication for Gastroesophageal Reflux: Manometric and pH-metric Postoperative Studies

From the Service of Thoracic Surgery, Hospital La Fé, and the Esophageal Laboratory, University Hospital, Valencia, Spain

Accepted for publication November 5, 1981.

^* Address reprint requests to Dr. París, Servicio de Cirugia Torácica, Departamento de Cirugía, Hospital La Fé, Ava. De Campanar 21, Valencia 9, Spain

From January, 1975, to December, 1980, 83 patients with sliding hiatal hernia, gastroesophageal reflux, or both were treated using a modified Collis gastroplasty associated with either partial or total gastric application. When partial plication was used, the five-year clinical results were considered satisfactory in 27 out of 35 patients (77%). When total plication was used, the results were satisfactory in 41 out of 46 patients (89%) after follow-up ranging from 12 to 60 months (average, 36 months), but no symptoms of gastroesophageal reflux reappeared in any patient.

In patients undergoing partial plication, the mean preoperative high-pressure zone of 11.20 ± 8.19 mm Hg increased after operation to 17.31 ± 10.50 mm Hg, but in the second postoperative studies the value decreased to 13.69 ± 7.24 mm Hg. When 360 degree plication was used, the preoperative value of the high-pressure zone—9.36 ± 4.80 mm Hg—increased after operation to 17.70 ± 7.53 mm Hg but did not decrease significantly in the second postoperative studies: 16.46 ± 7.99 mm Hg.

When partial plication was used, the positivity of the abdominal compression test was 9 and 28% in the early and late postoperative studies, respectively. Using total plication, the percentage of positivity in the early and late postoperative periods was 0 and 2%, respectively. Concerning the acid reflux test, when partial plication was used, the test was positive in 3 out of 27 patients (11%) in the early postoperative studies and in 7 out of 30 (23%) one year later. For the total plication proceclure, the percentage of positive tests was null in the first control and 3% in the second postoperative studies.

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