ABSTRACT
Obviously oesophageal transection interfere with the delicate anti-reflux mechanism and it is not surprising that some patients also complain of heartburn after operation. Fourty patients [35male [87.5%] and 5 female [12.5%], mean age 35 years] with portal hypertension and oesophageal varices were treated by splenectomy, gastro-esophageal devascularisation and oesophageal transection. Pre - and post-transection manometry was done for evaluation of changes in the lower oesophageal sphincter [LOS] pressure, length and function. The results revealed, a significant reduction in the lower oesophageal sphincter pressure [LOSP] following transection [mean 14.2 mmHg] than preoperatively [mean 21.8 mm Hg] The total lower oesophageal sphincter length [LOSL] was shortened postoperatively [mean, 2.5 cm] compared to the preoperative length [mean, 3.7cm]. The percentage of lower oesophageal sphincter relaxation [LOSR] although insignficant, it was lower postoperatively [mean, 8 0.3%] than preoperative measures [mean, 93.2%]. The stage is therefore set for reflux of gastric contents and these patients should be placed on anti-reflux medication routinely. Whether the additional technical difficulty of doing an anti-reflux procedure with the oesophageal transection in patients with portal hypertension is warranted requires