Fundoplication as prophylaxis of reflux-esophagitis in patients with varicose esophageal veins

Abstract

Aim. To investigate the condition of esophageal mucosa (EM) before and after surgical and endoscopic treatment of varicose esophageal veins (VEV). Material and methods. EM was examined in 100 patients (64 males and 36 females aged 33-74 years, mean age 52.8±5.7 years) with hepatic cirrhosis (HC). Of them, 80 patients have undergone endoscopic ligation of the esophageal veins, 20 patients - surgical disconnection of the azigoportal blood flow according to the original method with additional fundoplication. All the patients had intrahepatic portal hypertension caused by HC of different etiology. Results. Before operation, 70% patients had inflammation-induced alterations of the EM of different severity. Endoscopic ligation of the esophageal veins did not change the rate of EM inflammation detection. In operated patients reflux-esophagitis was detected significantly less frequently. Conclusion. The above results show efficacy of fundoplication as a method of esophagitis prevention. Esophagitis is one of VEV hemorrhage risk factors. Fundoplication is not easy to make and is not indicated for all HC patients, especially in urgent situations. However, in case of decision to operate for prevention of VEV hemorrhage, it is advisable to conduct fundoplication.

Keywords

• portal hypertension
• varicose esophageal veins
• reflux-esophagitis
• fundoplication