Surgical treatment of intractable esophagitis.

An operative technique combining a 360-degree fundoplication which is stabilized by anchoring the gastroesophageal junction to the middle arcuate ligament was used in a series of 140 patients since 1973. The patients were evaluated 1 year or more after surgery with clinical and radiographic assessment, regardless of complaints. Clinical results have been good in 91%. There has been no operative mortality and minor transient morbidity. X-rays done at least 1 year after surgery were compared with results obtained in 88 patients who had a modification of Hill's posterior gastropexy performed during the earlier years of this experience. The incidence of x-ray abnormalities with the posterior gastropexy was reduced from 23.5% to 5% when fundoplication was used in combination with a posterior gastropexy. The anchorage of the esophagogastric junction to the middle arcuate ligament allows a relatively loose fundoplication and thereby has reduced the incidence of disabling gas-bloat. Stabilizing the fundoplication prevents the occurrence of other complications related to fundoplication such as disruption, migration, and obstruction. This technique avoids the use of sutures in the esophageal wall, thus reducing the potential for perforation, fistula, or injury to the vagus nerves.