RECENT experimental studies13 in the dog have shown that the cardioesophageal sphincter may be incised and the resulting defect covered with a fold of gastric fundus in such a way that the peritoneal surface faces into the lumen. Healing takes place by the growth of esophageal mucosa across the serosa of the patch. In this way considerable enlargement of the lumen can be secured. In addition, folding the fundus of the stomach over the esophagus in this manner creates a long anterior spur which functions as a one-way valve protecting the esophagus from reflux.
In the past the major problem attending operative enlargement of the cardioesophageal sphincter has been the exposure of the unguarded esophagus to acid or biliary reflux.10 The present operation was designed to circumvent this by providing a large and yet protected lumen. Hitherto, severe acid peptic stricture had been satisfactorily managed only by arduous