A prospective study on the effect of the Belsey Mark IV 270-degree fundoplication on lower esophageal sphincter characteristics and esophageal body motility.

The effect of the Belsey Mark IV operation on lower esophageal sphincter characteristics and esophageal body motor function was prospectively studied in 38 patients who underwent successful operation (relief of symptoms, healing of esophagitis; group I) and 8 who had surgical failure (group II). Mean follow-up was 3 years (0.5 to 8 years). Only in group I a rise in basal lower esophageal sphincter pressure (from 8.3 +/- 0.8 mm Hg to 14.5 +/- 0.5 mm Hg, p < 0.001), total sphincter length (from 2.7 +/- 0.1 cm to 3.4 +/- 0.1 cm, p < 0.001), and the intraabdominal sphincter segment (1.3 +/- 0.1 cm to 2.3 +/- 0.1 cm, p < 0.001) with a reduction of the intrathoracic segment (from 1.5 +/- 0.1 cm to 1.1 +/- 0.1 cm, p < 0.05) was recorded. Preoperative and postoperative lower esophageal sphincter pressure and length values showed a large overlap. Antireflux operation had no effect on peristaltic amplitude, velocity, and duration, irrespective of the outcome of operation. One of five patients with incomplete swallow-induced lower esophageal sphincter relaxation had moderate dysphagia. Successful operation by 270-degree fundoplication is accompanied by a significant increase in lower esophageal sphincter pressure and length and does not affect esophageal body motor function.