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Biomedical subjects
Publications and source records attributed to V Guarner.
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In six patients with achalasia of the esophagus who previously underwent, one or more times, cardiomyotomy and had a failure of the procedure, we have done a new operation, an abdominal laterolateral anastomosis between the esophagus and the gastric fundus (Heyrowsky), wrapping it up with the stomach to form a genuine fundoplication. The six patients were preoperatively and postoperatively evaluated roentgenographically, endoscopically and manometrically, and the results were good with no reflux, and the drainage effect of the operation was excellent. This technique is a recourse for patients who have a recurrence of dysphagia after the Heller operation, because it has been ineffective, since it sometimes occurs in a rather large megaesophagus.
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Results over a 5 to 10 year period in 135 patients with hiatal hernia treated surgically by posterior fundoplasty were compared with results in a similar group of 40 patients undergoing Nissen fundoplication. The final results demonstrate the effectiveness of both procedures to relieve gastroesophageal reflux. However, the collateral effects with posterior fundoplasty are considerably less than those with the Nissen fundoplication. The lower esophageal sphincter was longer with fundoplasty than with the Nissen procedure.
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In posterior fundoplasty, a derivative of Nissen fundoplication, the fundus is passed behind the abdominal esophagus and fixed to the anterior aspect of the stomach, thus modifying the angle of entrance of the esophagus, creating a posterior gastric reservoir relatively inaccessible to the cardia. In dogs, it was a successful as a Nissen fundoplication in reversing esophagitis caused by reflux and daily administration of histamine. In another group of dogs, a cylindrical resection of the last 4 or 6 cm of the esophagus and a posterior fundoplasty were performed simultaneously. In spite of the daily administration of 30 mg of histamine, none of the dogs developed esophagitis. Posterior fundoplasty has proved effective in 14 patients with hiatal hernia observed for three years. In five patients undergoing a Heller myotomy for achalasia, it was used successfully to prevent postoperative regurgitation.
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