Experimnental and Clinical Studies on the Operative Treatment of Sliding Esophageal Hiatal Hernia and Achalasia of the Esophagus

Takuo Murakami, Hiroaki Ozasa, Atsushi Adachi, Masaaki Oka, Takashi Suzuki

Second Department of Surgery, Yamaguchi University School of Medicine

Among the components of the antireflux of the cardia in dogs, the lower esohageal sphincter (LES) is the most important and Willis' oblique muscle is next. In a comparison of 5 kinds of hiatal herniorrhaphies in dogs, LES pressure (LESP) increased after the operation in the following order; Nissen, Belsey Mark IV, Stensrud, Hill and Harrington methods. Responses to tetragastrin tended to increase after the Nissen and Belsey Mark IV procedures. No recurrences and no complications, such as fundoplication disruption, dysphagia and gas bloat syndrome, occurred in the 23 patients who undergone modified Nissen fundoplication at our clinic. The mean LESP increased from 27.2±2.8 cm H₂O preoperatively to 37.5±3.6 cmH₂O postoperatively. The effect of gastrointestinal hormones such as gastrin, secretin, VIP and substance P on LES were investigated in normal dogs, dogs with phenol-injected achalasia, normal patient and achalasia patients. Increase in the LESP response to tetragastrin injection was statistically greater in the achalasia dogs than in normal dogs. Increase in LESP response to tetragastrin was inhibited by previous injection of secretin in both normal and achalasia dogs. Radioimmunoassay revealed a decrease in VIP and substance P concentrations in the lower esophageal muscular layer in both achalasia dogs and patients. In patients with achalasia, the LESP increased significantly after intramuscular injection of tetragastrin at a dose of. 5 µg/kg. The Jekler and Lhotka method with long myectomy proved to be an excellent surgical procedure for achalasia of the esophagus because disturbance in passage was improved and then suitable high pressure zone to prevent postoperative reflux esophgitis was recostructed at the gastroesophageal junction.

Key words
lower esophageal sphincter, reflux esophagitis, esophageal achalasia

Reprint requests
Takuo Murakami The Seocnd Department of Surgery, Yamaguchi University School of Medicine
1114 Kogushi, Ube, 788 JAPAN

Accepted
June 13, 1990

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