[Gastroesophageal reflux. Anatomical, physiological and surgical aspects. Apropos of 61 consecutive cases of peptic esophagitis surgically treated with the same procedure].

Based on a literature review and a personal series of cases treated, it is considered that gastroesophageal reflux results mainly from a mechanical process. The importance of the gastric musculature is emphasized, particularly the oblique fibers which form a thick belt encircling the esophagogastric function. Reflux is assumed to be almost exclusively due to loss of fixation of the point of attachment of this belt which, because of its particular texture, allows gastric dilatation to be propagated to the esophagogastric junction. The principal cause is the angular movement of the mobilized cardia. The same result is observed after iatrogenic destruction of this so-called muscular belt. Ulcerated reflux esophagitis is considered to be a serious disease comparable to duodenal ulcer, and the operative technique used aims both at reducing gastric acidity (vagotomy) and the construction of an anti-reflux assembly based on Hill's method. Results of the application of these principles in 61 consecutive cases are discussed.