Eine experimentelle Untersuchung zur intraoperativen Erfolgskontrolle der laparoskopischen Nissen-Fundoplikatio

The postoperative dysphagia after the fundocation is caused by a too tight funduscuff. The 2-finger-test, known in the open procedure, can't be used in laparascopic procedure. The aim of our studies was to show possibilities of the intraoperative success control. 9 domestic pigs were test animals. A manometry followed after every operation step. 4 pigs got a floppy fundoplication, 5 a tight one. The width was judged by manometry, endoscopy, radiology and mechanic. In the end the fundoplication was judged after laparatomy. Results: In the manometry the LES was a two humped high pressure zone (length 7,95cm, interquartildistance(iqd) 3,45cm). The median pressure was 7 mmHg (15,9mmHg), increased after floppy fundoplication up to 28,5 mmHg(31,4mmHg) and after a tight one up to 37,8 mmHg (29.2mmHg). The integral over the high pressure zone was significantly different between floppy (median: 2483,9mmHgmm; iqd: 2984,5mmHgmm) and tight fundoplication (median:3849,2mmHgmm; iqd: 3004,5mmHgmm) with extensive interquartildistance. The sphincter vektor volume was 199950,33 mmHg2mm (iqd: 341874,14 mmHg2mm) in a floppy fundoplication and 426286,92 mmHg2mm (iqd: 620363,98 mmHg2mm) in a tight fundoplication. There is a significant difference (Wilcoxon p<0,01), but this is limited usuable by the extensive interquartildistance. There was a significant difference between the power needed to open the babcock forceps in a floppy fundoplication and the power needed in a tight one (floppy :6,5N+/-0,33N; tight:10,7N+/-0,52N)(p<0,01 Wilcoxon). The power to get over the fundoplication with a gastroscop was 7N+/-1,26N in the floppy fundoplication and 10,8N+/-0,4N (p<0.01) in the tight one. The diameter of the floppy fundoplication was 4,3 cm+/-0,4cm and the diameter of the tight fundoplication was 1,9cm+/-0,3cm. Conclusion: Because of the extensive interquartildistance the manometry was less reliable than the mechanic and endoscopic test to predict the tightness of fundoplication.

Grantor dc:publisher

Publikationsserver der RWTH Aachen University

Year dc:date

2002

Author dc:creator

• Grommes, Jochen

Contributors dc:contributor

• Schumpelick, Volker

• info:eu-repo/classification/ddc/610
• Medizin
• Chirurgie
• MIC

Statement dc:rights

• info:eu-repo/semantics/openAccess

Language dc:language

ger

Identifier

https://publications.rwth-aachen.de/search?p=id:%22RWTH-CONV-119286%22

OAI identifier oai:identifier

oai:publications.rwth-aachen.de:57230