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Antireflux effect of various operations for achalasia of the esophagus was investigated with the use of the manometric study. Operative procedures subjected to the present comparative study were proximal gastrectomy with end-to-end esophagosgastrostomy, Wendel procedure, Heller procedure and Fundic patch operation, each prepared in four mongrel dogs. Incidence of postoperative reflux with possible esophagitis was greatest in proximal gastrectomy followed by Wendel and Heller procedure. Fundic patch operation well prevented the reflux with greater values of pressure as well as dimension of the lower esophageal sphincter than those of the control series. In other series of experiments in dogs, an attempt was made to reveal the rationale of the effective valvular mechanism of the Fundic patch operation preparing various sizes of the valve. When compared by the manometric study, Fundic patch procedure with an incision of 6 cm in length, formation of the artificial mucosal valve and two thirds enclosure of the distal esophagus with the fundus like fundoplication sufficiently prevented the reflux. Preparation of the valve smaller in size accelerated the incidence of postoperative reflux.

MANOMETRIC STUDIES ON ANTIREFLUX EFFECT OF FUNDIC PATCH OPERATION