1 Revista do Colégio Brasileiro de Cirurgiões 2002 Vol: 29(5):. DOI: 10.1590/S0100-69912002000500002

Análise comparativa de três tipos de válvulas anti-refluxo associada à cirurgia de heller: estudo experimental em cães

OBJECTIVE: To compare three techniques of esophagogastrofundoplication – anterior, posterior and lateral-post cardiomyotomy, in dogs. METHOD: Pre-operative assessment included esophagoscopy plus biopsy of the mucosa, pH determination and manometry. The animals were divided into four groups: Group A: anterior anti-reflux valve (n=5); group P: posterior valve (n=5); Group L: lateral valve (n=5); Group C: control group, no fundoplication (n=10). After five weeks, the animals were submitted to endoscopy plus biopsy, pHmetric and manometric examinations and histopathological analysis. RESULTS: Histophatological examination detected esophagitis in every case of the control group and in nine cases of the groups with fundoplication. When present, esophagitis was milder in the valve groups than in the control group. The average value of the pressure in high pressure zone (HPZ) detected by manometric examination in the control group, was significantly reduced after cardiomyotomy (39,2 to 23.4mmHg). In the groups with fundoplication, there was no significant difference between preoperative and postoperative mean values of the HPZ pressure. The values detected preoperatively in groups A, P and L were 39.7, 39.9, and 39.7mmHg respectively and 40.9, 44.8 and 41.3 mmHg postoperatively. CONCLUSIONS: 1) cardiomyotomy causes gastroesophageal reflux and esophagitis; 2) any type of fundoplication valve, added to the myotomy, restores the lenght and the pressure of the HPZ=ZAP and reduces the incidence of reflux and esophagitis.

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