Transdiaphragmatic pressure gradients and the lower esophageal sphincter after tight abdominal wall plication in the rat

Abstract

Background: Gastroesophageal reflux (GER) is increasingly recognized as a complication of surgical closure of gastroschisis and omphalocele. Aim: This study tests the hypothesis that forceful abdominal wall closure reinforces the transdiaphragmatic pressure gradients that constitute the main GER-driving force and challenges the antireflux barrier. Materials and Methods: Abdominal and esophageal pressures as well as lower esophageal sphincter pressures (LESP) and length (LESL) were measured in 17 adult rats before tight abdominal wall plication, after it, and 1 week later. Results: This maneuver increased the transdiapragmatic expiratory gradient from 0.67 ± 1.31 to 6.97 ± 2.68 mm Hg ( P < .01) and the inspiratory gradient from 4.36 ± 1.13 to 10.79 ± 2.31 mm Hg ( P < .01) by markedly increasing both the expiratory (from 1.47 ± 0.74 to 9.44 ± 1.85 mm Hg; P < .01) and inspiratory (from 0.98 ± 0.69 to 6.83 ± 1.55 mm Hg; P < .01) intraabdominal pressures. These changes were transient, and all pressures became normal after 1 week. The antireflux barrier functioned properly under these new conditions because both LESP and the diaphragmatic pinch-cock pressure (DPP) increased, from 20.3 ± 3.63 to 26.5 ± 4.31 mm Hg ( P < .01) and from 16.4 ± 7.25 to 22.5 ± 4.36 mm Hg ( P < .01), respectively, while LESL remained unchanged. Conclusion: Tight abdominal wall plication in the rat generates high intraabdominal pressures and thus reinforces the transdiaphragmatic pressure gradients, but these conditions elicit a healthy barrier response with sphincteric reinforcement. In addition, these changes are transient and fade out some time after operation. These facts should be taken into account for understanding the pathogenesis of GER after repair of abdominal wall defects in human babies.