Title: Evaluation of the use of the median arcuate ligament in fundoplication for reflux esophagitis
Abstract: A prospective evaluation was performed of the operative treatment of reflux esophagitis. The operative procedure consisted of a 360 ° wrap of the distal esophagus with the fundus of the stomach and anchoring the fundoplication to the median arcuate ligament to maintain it in the positive pressure environment of the abdominal cavity. Thirty-five patients were treated for symptoms of reflux esophagitis refractory to medical therapy. Preoperative evaluation consisted of standard x-ray films and endoscopy as well as pH electrode reflux testing and LESP measurement. Postoperative evaluation revealed favorable clinical results, with only one patient having recurrent esophagitis and this only temporarily. Adverse sequelae of the operation were minimal. After a mean follow-up of 34.2 ± 3.6 months, mean preoperative LESP measurements of 8.4 ± 0.4 cm H2O were elevated postoperatively to 22.0 ± 1.0 cm H2O, and LESP levels increased in every patient. Of seven patients with hard stricture formation treated by dilation, fundoplication, and anchoring of the wrap to the median arcuate ligament, four are available for satisfactory long-term evaluation. After a mean follow-up of 26 ± 6 months, these patients have mean LESP measurements of 26.7 ± 2.2 cm H2O and do not require dilation. Two additional patients with esophageal ulcer formation, two with gastric heterotopia, and four with one or more previous operative repairs directed at a hiatus hernia or reflux esophagitis remain free of symptoms and esophagitis at the time of this report.
Publication Year: 1977
Publication Date: 1977-12-01
Language: en
Type: article
Indexed In: ['crossref', 'pubmed']
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Cited By Count: 16
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