Luciano Poggi, MD, Felix Camacho, MD, Gerardo Arredondo, MD, Luis Poggi, MD, FACS. Clinica Anglo Americana
Introduction: Hiatal hernia, esophageal and gastric dysmotiliy are associated with reflux. Recently, there has been significant interest in understanding the etiology of “De Novo” reflux in sleeve gastrectomy, however this remains unclear.
Objective: To understand the physical and mechanical relationship of the different factors involved in the antireflux valve in a porcine model and the result of recreating a sliding hiatal hernia as well as a Sleeve gastrectomy.
Methods: Porcine stomachs and esophagus were harvested and taken to the laboratory. The models used were: 1) Porcine stomach and esophagus without any alteration, 2) Sliding Hiatal hernia model created after the sling and muscular fibers at the Gastroesophageal junction were divided, 3) His angle repair and 4) Sleeve gastrectomy model.
All models underwent two tests. The first test consisted on filling the stomachs, while lying horizontally on the table, with water through the duodenum up to distention. The intragastric pressure was monitored and registered at the moment of leakage. The sleeve gastretomy model was filled with 75 cc of water. If no leak was detected on the first test, a second test was performed, consisting on putting the model upside down.
Results: We observed that the distention of the fundus in a complete stomach generates pressure against the esophagus collapsing its lumen. The full stomach model did not leak on any tests. The Hiatal hernia model did leak after test one without even any measurable intragastric pressure. The model with His angle repair model did leak after, however the stomach required to be significantly distended. The Sleeve gastrectomy model leaked after the first test.
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Conclusion: The mechanical properties of the His angle-sling fibers-fundus complex seems to be the main factor in avoiding reflux in the ex-vivo porcine models. This could potentially explain why sleeve gastrectomy procedure produces reflux per se.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79725
Program Number: P369
Presentation Session: Poster (Non CME)
Presentation Type: Poster
