J.Jpn. Surg. Soc.. 86(9): 1153-1156, 1985

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Report on the annual meeting

GASTROINTESTINAL HORMONES AND OPERATIONS FOR ACHALASTA OF THE ESOPHAGUS AND SLIDING ESOPHAGEAL HIATAL HERNIA, THEIR SURGICAL SIGNIFICANCE

Experimental achalasia dogs produced with Deloyer’s method showed higher resting pressure at the gastroesophageal junction and the increase in LES pressure in response to tetragastrin and cholecystokinin. Dose-response curve of the LES to each dose of tetragastrin in achalasia dog shifted to the left. Resting LES pressure in 11 patients with achalasia was 42.73±23.31cm H₂O. It increased significantly after intramuscular injection of 5μg/kg of tetragastrin and fiuoroscopic observation showed the tonic contraction of the lower esophagus and cardia. After the performance of Jekler-Lhotka operation, LES pressure decreased to lower values sufficient to prevent the gastroesophageal reflux. Comparing 5 kinds of hiatal herniorrhaphies in dogs, LES pressure increased postoperatively in the following order : Nissen, Belsey Mark IV, Stensrud, Hill and Harrington methods. Responses to tetragastrin increased after Nissen and Belsey Mark IV methods. In 12 out of 21 clinical cases of sliding esophageal hiatal hernia who had undergone Nissen-Rossetti method adding fundopexy and posterior gastropexy, preoperative esophageal manometry showed HPZ of 24.98±8.87cmH₂O in peak value and 5.1±3.46cm in length. Seven cases showed the biphasic pattern and 5 cases showed the negative response to tetragastrin. Postoperative manometry showed HPZ of 31.42±18.46cmH₂O in peak value and 4.5±1.73cm in length. One case showed the biphasic pattern and 3 cases showed the negative response to tetragastrin.

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