Selection of Operative Procedures for Reflux Esophagitis

Yoichi Tabira, Toshitada Okuma¹⁾, Yoshitsugu Torigoe²⁾, Hirohumi Kaneko³⁾, Katsunori Ikegami, Keiichiro Kondo, Norihisa Hanada, Hiroaki Hongo, Nobuo Kitamura

The First Department of Surger, Kumamoto University, School of Medicine
¹⁾Department of Surgery, Izumi City Hospital
²⁾Department of Surgery, Ueki City Hospital
**Department of Surgery, Yamaga City Hospital

To determine the efficacy of the operative procedures for reflux esophagitis, the 30 patients including 8 patients with esophageal stricture (shortening) were retrospectively reviewed. Twenty-two of the 30 patients with noncomplicating Grade O-III esophagitis underwent the modified Hill technique plus 270-degree fundoplication. The AFP grade was determined for 12 of the 22 patients before and after the operation. All 12 patients improved in A grading, 11 patients (92%) improved in F grading, and 10 patients (83%) improved in P grading after the operation. Intraoperative esophageal manometry showed a significant elevation of lower esophageal sphincter pressure (LESP) after the repair (18.4∼38.2 mmHg). Among the 8 patients with esophageal stricture, 4 underwent the Collis-Nissen operation, 3 with dilatable stricture underwent Belsey Mark IV repair, and one with an undilatable stricture underwent resection of the lower esophagus and cardia. Reflux symptoms have recurred in 2 patients treated by inadequate fundoplication of the Collis-Nissen operation. Three patients treated with Belsey-Mark IV repair have been relieved of reflux with adequate levels of LESP after the operation (11.0 mmHg, 18.7 mmHg and 31.3 mmHg). In conclusion, a modified Hill technique plus 270-degree fundoplication is a suitable procedure for noncomplicating reflux esophagitis, and Belsey Mark IV repair is a useful operation for complicating reflux esophagitis with stricture. Preopertive dilatation and esophageal manometry are essential to indicate the need for an operative procedure for reflux esophagitis with stricture.

Key words
reflux esophagitis, short esophagus, modified Hill technique, Belsey Mark IV repair, esophageal manometry

Reprint requests
Yoichi Tabira The First Department of Surgery, Kumamoto University School of Medicine
1-1-1 Honjo, Kumamoto, 860 JAPAN

Accepted
October 9, 1996

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