Cardiaplication as a novel antireflux procedure for infants: a proof of concept in an infant porcine model.

Abstract

INTRODUCTION: Current surgical techniques for gastroesophageal reflux in infants involve gastric fundoplication and crural repair. These operations are complicated by a high recurrence rate in the infant population. The primary cause of failure is generally related to recurrent hiatal hernia. Minimal dissection of the gastroesophageal junction has been linked to reduced hiatal hernia formation. We propose an alternative plication technique for modifying the gastroesophageal junction called cardiaplication. In an effort to evaluate the effectiveness of this alternative plication technique, an animal model was developed. MATERIALS AND METHODS: After Institutional Animal Care and Use Committee approval, 12 Yucatan piglets, weighing 10-12&#x2009;kg, underwent laparotomy and cardiaplication. Plication was performed by embrocating the cardia of the stomach and secured with two or three interrupted sutures over a 1-cm length. The technique was then evaluated by comparing cardia yield pressures (CYPs). Pre- and postoperative CYPs were determined by filling the stomach with water until the cardia became incompetent. These values were compared using Student's t test for paired samples. RESULTS: Cardiaplication was successfully completed in all pigs. CYP increased in all animals after cardiaplication from a mean of 12.5&#xb1;9.6 to a mean of 76&#xb1;25&#x2009;cm of H(2)O (P<.001). DISCUSSION: Cardiaplication results in an increase in CYP in young pigs. This procedure may be an alternative antireflux operation for infants. With cardiaplication there is the potential benefit of not needing to modify the crura or the gastroesophageal junction. This may translate into fewer postoperative complications and less need for reoperations due to recurrent hiatal hernia.