The author replies

Abstract

We thank Mr. Watson for his interest in our paper [1] and his comments. In addition we think it is very exciting that he has done a similar experimental study, which will be published soon. It is important that Mr. Watson informs the interested reader that the anatomy of the stomach in a pig shows a very mobile fundus without the need to divide any so-called ''short gastric'' vessels. We were aware of the fact when planning the study that with the pigs we used a model that did not require any mobilization of the fundus. We consider this an advantage of the pig model because we have experienced the mobilization of the fundus as a prerequisite for a tension-free fundoplication in men when using only a limited dissection on the lesser curvature. This limited dissection shall prevent damage to the antral and hepatic vagal branches and to create a limited space for the posterior fundic flap, which prevents slipping [2].In North America and Australia the Nissen-Rossetti version is known as a fundoplication technique without division of the short gastric vessels as described in earlier years [3]. In central Europe, the Nissen-Rossetti version is performed with extensive mobilization of the fundus and division of the short gastric vessels [4,5]. As a consequence, in preparing the study, it was no conceptual problem for us, but an advantage that the fundus in the pig is so mobile that the division of the short gastric vessels is not necessary. It is therefore somewhat surprising that Mr. Watson focuses his comment on the mobilization of the fundus and division of the short gastric vessels, even though this has not been the subject of our paper. He points out that the increased mechanical augmentation of the Nissen-Rossetti version in our study is almost certainly related to the length of the wrap. We completely agree and also are convinced that the length of the wrap is a very important criterion for the extent of the mechanical augmentation that a fundoplication can create. In addition, we think that shaping the wrap with the anterior wall of the fundus around the backside of the esophagus and reunifying this anterior aspect with the lower anterior part of the fundus in the Nissen-Rossetti technique can also be responsible for an increased mechanical effect. Therefore, we interpret our results to mean that both the length and the way of constructing the fundoplication can have a mechanical effect on the lower esophageal highpressure zone.In addition, Mr. Watson points out recent reports from his group that postoperative sphincter pressure measurements have a weak correlation with clinical outcome. With great interest we have carefully studied these reports because in contrast, we do see in our patients a good correlation between the improved parameters of the manometric criteria of mechanical incompetence that we use in our laboratory and the clinical outcome and quality of life of our patients after laparoscopic antireflux surgery. When studying these reports, our conclusion was that the two laboratories use different m...