Highly Selective Vagotomy, Posterior Gastropexy, and Calibration of the Cardia for Reflux Esophagitis

  • A. Csendes
Conference paper


Posterior gastropexy used as one of the definitive antireflux operations in patients with reflux esophagitis was introduced by Hill [28]. The basic principle of this procedure is to anchor the anterior and posterior phreno-esophageal fascial bundles to the median arcuate ligament, thus creating a long and permanent intraabdominal segment of the esophagus. Larraín modified this operation by adding the concept of calibration of the cardia [31], because several surgical observations indicated that the distal portion of the esophagus and the esophagogastric junction were both dilated in patients with reflux esophagitis [13, 29, 30,43]. This surgical maneuver aimed to decrease the diameter of the muscular esophagogastric junction (or “cardias”) to a normal or lesser than normal diameter. This was first controlled by invaginating the stomach by a finger against the distal end of the esophagus and this step was accepted by Hill and other surgeons [26, 30, 41, 43]. We have employed this surgical procedure for several years [13, 32,42] but much surgical experience and some complications seen during and late after surgery led us to introduce some modifications to the technique [21, 24, 33, 36, 44, 46].


Duodenal Ulcer Hiatal Hernia Reflux Esophagitis Esophageal Stricture Esophagogastric Junction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Amdrup E (1977) Parietal cell (highly selective) vagotomy for duodenal ulcer. In operative surgery. In: Dudley H, Rob C, Smith R (eds). Abdomen 3rd ed. butterworth, London, pp 137–141Google Scholar
  2. 2.
    Bahadorzadek K, Jordan PH (1975) Evaluation of the Nissen fundoplication for treatment of hiatal hernia: use of parietal cell vagotomy without drainage as an adjunctive procedure. Ann Surg 181:402–408CrossRefGoogle Scholar
  3. 3.
    Behar I, Brand DL, Brown FC, Castell DO (1978) Cimetidine in the treatment of symptomatic gastroesophageal reflux. Gastroenterology 74:441–448PubMedGoogle Scholar
  4. 4.
    Boesby S (1977) Relationship between gastroesophageal acid reflux, basal gastroesophageal sphincter pressure and gastric acid reaction. Scand J Gastroenterol 12:547–553PubMedCrossRefGoogle Scholar
  5. 5.
    Braasch IW, Sala LE, Ellis EH (1980) Parietal cell vagotomy. Its effect in lower esophageal sphincter function. Arch Surg 115:699–701PubMedCrossRefGoogle Scholar
  6. 6.
    Braghetto I, Csendes A, Velasco N (1985) Gastroesophageal reflux in gastric and duodenal ulcer patients before and after definitive surgical treatment. A prospective study. In: De Meester TR, Skinner DB (eds) Esophageal disorders. Pathophysiology and therapy. Raven, New York, pp 155–163Google Scholar
  7. 7.
    Bremner CG (1979) Gastric ulceration after a fundoplication operation for gastroesophageal reflux. Surg Gynecol Obst 148:62–64Google Scholar
  8. 8.
    Bushkin FL, Woodward ER, O’Learly JP (1976) Occurrence of gastric ulcer after Nissen fundoplication. Am Surg 42:821–826PubMedGoogle Scholar
  9. 9.
    Casten DF (1967) Peptic esophagitis, hiatus hernia and duodenal ulcer: a unified concept. Am J Surg 113:638–641PubMedCrossRefGoogle Scholar
  10. 10.
    Clarke ID, Gordon HE, Winner RB (1964) Treatment of hiatus hernia by hiatus herniora-phy, vagotomy and drainage procedure. Am J Surg 107:253–257CrossRefGoogle Scholar
  11. 11.
    Collis JL (1968) Surgical control of reflux in hiatus hernia. Am J Surg 115:465–471PubMedCrossRefGoogle Scholar
  12. 12.
    Cordiano C, Della Rovere GA, Agugiaro S, Mazielli G (1976) Technical modification of the Nissen fundoplication procedure. Surg Gynecol Obstet 143:997–978Google Scholar
  13. 13.
    Csendes A, Larraín A (1972) Effect of posterior gastropexy on gastroesophageal sphincter pressure and symptomatic reflux in patients with hiatal hernia. Gastroenterology 63:19–24PubMedGoogle Scholar
  14. 14.
    Csendes A, Larraín A, Uribe P (1974) Gastric acid secretion in patients with a symptomatic gastroesophageal reflux and patients with esophageal strictures. Ann Surg 179:119–121PubMedCrossRefGoogle Scholar
  15. 15.
    Csendes A, Larach J, Godoy J (1978) Incidence of gallstones development after selective hepatic vagotomy. Acta Chir Scand 144:289–291PubMedGoogle Scholar
  16. 16.
    Csendes A, Oster MI, Moller IT, Flynn I, Amdrup E (1978) Gastroesophageal reflux in duodenal ulcer patients before and after vagotomy. Ann Surg 188:804–808PubMedCrossRefGoogle Scholar
  17. 17.
    Csendes A, Oster M, Brandsborg O (1978) Gastroesophageal sphincter pressure and serum gastrin in relation to food intake before and after vagotomy. Scand J Gastroent 13:437 – 441Google Scholar
  18. 18.
    Csendes A, Oster M, Moller IT, Brandsborg M, Amdrup E (1979) Effect of extrinsic denervation of the lower end of the esophagus on study and cholinergic stimulated gastroesophageal sphincter in man. Surg Gynec Obst 148:375–378Google Scholar
  19. 19.
    Csendes A, Oster M, Brandsborg O, Moller IT, Amdrup E (1979) Effect of vagotomy on human gastroesophageal sphincter pressure in the resting state and following increases in intraabdominal pressure. Surgery 85:419–424PubMedGoogle Scholar
  20. 20.
    Csendes A, Velasco N, Amat J (1979) Highly selective vagotomy: preoperative studies and mortality. Rev Chil Cir 31:165–170Google Scholar
  21. 21.
    Csendes A (1981) A modified posterior cardio-gastropexy for surgical treatment of gastroesophageal reflux with the adding of highly selective vagotomy and bougie calibration. In: Stipa S, Belsey R, Moraldi A (eds) Medical and surgical problems of the esophagus. Symposium 43. Academic, London, pp 91–95Google Scholar
  22. 22.
    Csendes A, Miranda M, Espinoza M, Braghetto I (1981) Perimeter and location of the muscular gastroesophageal junction or cardia in control subjects and in patients with reflux esophagitis or achalasia. Scand J Gasteroenterol 16:951–956CrossRefGoogle Scholar
  23. 23.
    Csendes A, Braghetto I (1984) Reflux esophagitis. Acad Chir 28:307–318Google Scholar
  24. 24.
    Csendes A, Braghetto I, Velasco N (1985) A comparison of three surgical techniques for the treatment of reflux esophagitis: a prospective study. In: DeMeester T, Skinner DB (eds) Esophagel disorders: pathophysiology and therapy. Raven, New York, pp 171–181Google Scholar
  25. 25.
    Dodds WI, Hogan WI, Helin JI (1981) Pathogenesis of reflux esophagitis. Gastroenterology 81:376–394PubMedGoogle Scholar
  26. 26.
    Hemreck AS, Coates NR (1980) Results of the Hill antireflux operation. Ann J Surg 140:764–767CrossRefGoogle Scholar
  27. 27.
    Herrington JL (1962) Treatment of esophageal hiatal hernia. Arch Surg 84:379–389CrossRefGoogle Scholar
  28. 28.
    Hill LD (1967) An effective operation for hiatal hernia: an eight year appraisal. Ann Surg 166:681–692PubMedCrossRefGoogle Scholar
  29. 29.
    Hill LD (1972) Editorial: surgery and gastroesophageal reflux Gastroenterology 63:183–185PubMedGoogle Scholar
  30. 30.
    Hill LD (1977) Progress in the surgical management of hiatal hernia. World J Surg 425–438Google Scholar
  31. 31.
    Larraín A (1971) Technical consideration in posterior gastropexy. Surg Gynecol Obstet 122:299–300Google Scholar
  32. 32.
    Larraín A, Csendes A, Pope CE (1975) Surgical correction of reflux as effective therapy for benign esophageal strictures. Gastroenterology 69:578–583PubMedGoogle Scholar
  33. 33.
    Maddern OJ, Chatterton BE, Collins PJ (1985) Solid and liquid gastric emptying in patients with gastroesophageal reflux. Br J Surg 72:344–347PubMedCrossRefGoogle Scholar
  34. 34.
    Mustard RA (1970) A survey of techniques and results of hiatus hernia repair. Surg Gynecol Obstet 130:131–136PubMedGoogle Scholar
  35. 35.
    Oowen JPC, Wittebal P, Geverts WJC (1979) Lower esophageal sphincter function after highly selective vagotomy. Arch Surg 114:908–910CrossRefGoogle Scholar
  36. 36.
    Oster MT, Csendes A, Funch-Jensen P, Amdrup E (1982) PCV and modified Hill procedure as surgical treatment of reflux esophagitis: results in 108 patients. World J Surg 6:412–417PubMedCrossRefGoogle Scholar
  37. 37.
    Pearson FG, Store RM, Parrish RM (1969) Role of vagotomy and pyloroplasty in the therapy of symptomatic hiatus hernia. Am J Surg 117:130–137PubMedCrossRefGoogle Scholar
  38. 38.
    Pearson FG, Langer B, Henderson RD (1971) Gastroplasty and Belsey hiatus hernia repair J Thorac Cardiovasc Surg 61:50–63PubMedGoogle Scholar
  39. 39.
    Sankar MY, Old JM, Trinder P, Base AAK (1976) The advantages of combining posterior gastropexy with proximal gastric vagotomy. Clin Gastroenterol 10:389–392Google Scholar
  40. 40.
    Sifers EC, Taylor TL, Rick GG (1976) The role of gastrin in the treatment of sliding hiatal hernia with reflux using the reefing method of fundoplication. Surg Gynecol Obstet 143:376–380PubMedGoogle Scholar
  41. 41.
    Thomas AN, Hael AD, Haddad JK (1973) Posterior gastropexy. Am J Surg 126:148–156PubMedCrossRefGoogle Scholar
  42. 42.
    Uribe P, Csendes A, Larraín A (1973) Evaluation of surgery for gastroesophageal reflux. Rev Med Chile 101:125–128PubMedGoogle Scholar
  43. 43.
    Vansant JH, Baker JW, Ross DG (1976) Modification of the Hill technique for repair of hiatal hernia. Surg Gynecol Obstet 143:637–642PubMedGoogle Scholar
  44. 44.
    Velasco N, Hill LD, Gannon R (1982) Gastric emptying and GER. Am J Surg 144:58–62PubMedCrossRefGoogle Scholar
  45. 45.
    Wesdorp ICE, Bartelsman J, Schipper MEI, Tytgat GN (1981) Effect of long term treatment with Cimetidine and antacids in Barrett’s esophagus. Gut 22:724–727PubMedCrossRefGoogle Scholar
  46. 46.
    Wilbur BG, Kelly KA (1973) Effects of proximal gastric and truncal vagotomy on canine gastric activity, motility and emptying. Ann Surg 178:295–299PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 1988

Authors and Affiliations

  • A. Csendes
    • 1
  1. 1.Department of SurgeryUniversity of ChileSantiagoChile

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