Lower esophageal sphincter function after highly selective vagotomy.

We evaluate whether highly selective vagotomy (HSV) might disturb functional integrity of the lower esophageal sphincter (LES). Special interest was directed to changes in position of the LES in relation to the diaphragm, LES pressure, and pH reflux pattern. The conditions of 20 patients were evaluated by manometric studies and by 12-hour overnight pH measurements before and 14 days after HSV; five of them were also studied one year after HSV. The results indicate: (1) There is a slight elongation of the LES in the early postoperative phase, which seems to disappear after one year. (2) The position of the diaphragm as measured manometrically by the pressure inversion point descends in relation to the LES 14 days after HSV, and it does not seem to return to its original position after one year. (3) There is no significant change in LES pressure after HSV. (4) There is no increase in reflux after HSV.