When a stricture is present in association with gastroesophageal reflux, each of the following is an acceptable repair for reflux control except one. Identify the poorest repair

E. Partial fundoplication.

DISCUSSION: When a stricture is present, periesophagitis and shortening limit the chances of obtaining a sufficient length of intra-abdominal esophagus. Even extensive mobilization of the esophagus to the aortic arch and freeing of the esophagogastric junction does not afford a comfortable 4 to 5 cm. of esophagus under the diaphragm. A tension-free repair is not possible in such circumstances. Partial fundoplication at this stage of the disease is followed by a 45% failure rate. Excellent results have been reported using a total fundoplication following dilatation of the stricture, and intrathoracic fundoplication provided good results. The lengthening gastroplasty with a partial fundoplication or with total fundoplication shows satisfactory control of reflux in a majority of patients.