Between 1974 and 1987, we performed 18 left colonic interpositions for benign oesophageal disease: caustic lesions in 6 patients, undilatable reflux stenosis in 5, reoperative peptic strictures in 5, penetrating wound in 1 and iatrogenic stricture following oesophagogastric transection for bleeding in 1. Four patients were women. The mean age was 40 +/- 19 years. In 10 patients a left thoracotomy was used; in the other 8 a cervico-abdominal approach was employed. One patient died postoperatively from liver failure. The mean follow-up was 11 +/- 4 years. Clinical results were excellent or good in 12 of the remaining 17 patients (71%). These results varied according to the length of colon interposition; in patients with long colonic interposition, poorer results were achieved. The motor activity of the colonic transplant was evaluated by manometric studies. After intraluminal injection of 30 ml of liquid, the colon responded uniformly with sequential peristaltic waves. Transmission of the oesophageal waves through the oesophagocolic anastomosis was studied in 2 patients. After wet swallows, the oesophageal contractile waves were followed by colonic waves. Solid radionuclide colonic transit studies were carried out in 18 control subjects and in 18 patients with colon interposition. In subjects with a normal oesophagus, the general pattern was rapid emptying of the bolus through the oesophagus. Findings in patients with a short transplant were similar to those observed in normal oesophagi. In most patients with long transplants the transit was abnormal.(ABSTRACT TRUNCATED AT 250 WORDS)

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To analyze postprandial gastroesophageal reflux by means of ambulatory gastroesophageal pH monitoring for 24 h, four groups were studied prospectively: group A: 22 healthy volunteers; group B: 31 consecutive patients undergoing medical treatment for gastroesophageal reflux, group Cl: 20 consecutive patients with symptomatic reflux awaiting surgical treatment by means of Nissen fundoplication (pre-Nissen evaluation) and group C2: group C1 patients reevaluated 6 months postoperatively (post-Nissen evaluation). Gastroesophageal pH, as a measure of post-prandial reflux following the main meal of the day was evaluated by the Kaye test. In groups B, C1 and C2, esophageal manometry was also performed. Gastroesophageal pH monitoring revealed significant qualitative as well as quantitative differences in postprandial gastroesophageal reflux experienced by healthy subjects (group A) and surgically treated patients (group C2) compared to patients with pathologic reflux (groups B and C1). The postprandial reflux was significantly more acid and more important (Kaye’s test value) in groups Cl and B than in groups A and C2. There were no differences in postprandial reflux between healthy subjects and patients treated by Nissen fundoplication (group C2). Only the pressure and length of the lower esophageal sphincter (LES) showed differences after Nissen fundoplication. We conclude that patients with pathologic reflux have more severe postprandial reflux than normal subjects; Nissen fundoplication corrects the degree of postprandial reflux to a normal range by elevating the LES pressure (11.3 × 1.4 vs. 22.4 ± 1.6 mm Hg; p < 0.001) and length (2.7 ± 0.2 vs. 3.7 ± 0.1 cm; p < 0.001) in our patients.