EVALUATION OF ANTIREFLUX EFFECT OF FUNDIC PATCH OPERATION BY WITHDRAWAL PH CURVE

With the use of gastroesophageal withdrawal pH curve, pathophysiology after various surgical procedures for achalasia of the esophagus was investigated experi-mentally from the view point of postoperative reflux. A total of 68 dogs were divided into four groups and were prepared with proximal gastrectomy with end-to-end esophagogastrostomy, Wendel procedure, Heller procedure and Fundic patch opera-tion, respectively. In the group with Fundic patch operation, efficacy of the flap valve, mucosal valve and fundoplication was also evaluated preparing them in various sizes.The results obtained may be summarized as follows:1) Withdrawal pH measurement is a sentive mean to detect the gastroesophageal reflux.2) Proximal gastrectomy with end-to-end esophagogastrostomy and Wendel procedure yielded worst results with severe gastroesophageal reflux. On the contrary, Fundic patch operation best controlled the gastroesophageal reflux.3) Gastroesophageal reflux could be prevented by the Fundic patch operation with the flap valve 6 cm in length and fundoplication enclosing around 1/2 to 2/3 circumference of the distal esophagus.