Prevention of Wrap Disruption After Antireflux Surgery: an Experimental Study

Abstract

Objective: The worst complication after a fundoplication is the disruption of the fundic wrap which is the main cause of recurrent gastro-esophageal reflux. The purpose of this experimental study is to seek for an alternative technique to prevent wrap-breakdown. Material and Method: The experiments were carried out on thirty canine subjects those were randomly allocated into 3 groups for performance of a Nissen procedure. Silk sutures were used for construction of the fundic wrap in Group I, silk sutures and fibrin glue were used in Group II and only fibrin glue was used in Group III for the same purpose. Operation durations were noted as minutes. The break-down force of the fundic wrap was measured and recorded. The results were recorded as kg and statistical examinations were performed by SPSS 13.0 statistical software program. The intergroup comparisons were performed with Kruskal-Wallis and Mann-Whitney U tests. p was significant at <0.05 Results: No post-operative complications were observed and all the animals survived until the post-operative 2nd month when they were euthanized and the wrap break-down forces were determined. The break-down force was 11.2 kg in Group I, 17.3 kg in Group II, and 11.5 kg in Group III. The difference between group I and II, with group III was statistically significant (p<0.05). But group I and III was not statistically significant (p>0.05). Operation times were 47.9 in Group I, 53.2 in Group II and 28.38 minutes in Group III. Operation times were significantly longer in Group II than in Group I and III (p<0.05), and significantly shorter in Group III than in Groups I and II (p<0.05). Conclusion: We believe that, application of the fibrin glue together with the conventional suturing technique in construction of the fundoplication may prevent wrap-breakdown after the Nissen antireflux procedure.