Background. Postoperative dysphagia (ranges from 3.7 to 14.3 %) and recurrence of reflux (occurs in 4.5-8.0 % of cases) are most common among the adverse results of antireflux procedures. One of the options to improve the results of operative treatment is adaptation of surgical methods to the mechanisms of functioning of the lower esophageal sphincter (LES).
Materials and methods. The study of electrical and motor activity of LES allowed to calculate the contribution of the diaphragmal crura and to develop modifications of traditional methods with fixation of fandic warp to cruroplasty zone. Traditional methods — 27 laparoscopic Nissen fundoplication (GERD patients), and 20 laparoscopic Dor patients (achalasia) are performed in investigation groups. We performed modified methods of surgical correction in 35 patients with GERD and 15 with achalasia of comparision groups.
Results. Esophageal manometry showed that mean relaxation LES pressure in traditional and modified Nissen procedure were (97.2±1.7) and (4.3±1.2) mm Hg respectively (p<0.05), basal LES tone was (26.4±3.8) and (27.5±4.6) mm Hg respectively (p>0.05). In achalasia group basal pressure were (15.8±2.1) mm Hg in Dor and (23.5±2.3) mm Hg modified Dor procedure (p<0.05), relaxation pressure were (7.7±1.8) and (4.5±0.8) (p<0.05). DeMeester index and dysphagia incidence were significantly lower in investigation groups.
Conclusion. Cruroplasty with warp fixation is significant component in antireflux procedure, which allows use crus of the diaphragm to recreate the functionally active cardia that provides good functional results of operations, allowing to achieve good antireflux function of the cardia and keep its ability to relax.