JSLS ficient reassurance to GE integrity. Much higher volumes of air and many more manipulations of the stomach were required to demonstrate injuries when the pylorus alone was occluded. Indeed, the technique of proximal stom- ach occlusion was adapted from our clinical practice in which the distal stomach alone is occluded. It was added because we were dissatisfied with our ability to detect esophageal injuries in the pig model using pyloric occlusion alone. Proximal stomach occlusion and insuf- flation appears to effectively detect esophageal injuries of likely clinical importance (size range >2.5 mm). Pyloric occlusion and insufflation effectively evaluates the stom- ach for injury (size >2.5 mm) but, as noted, may miss esophageal defects. When combined, these two compo- nents of GIT provide a useful method for detecting GE injury after LNF. Damage to the stomach and esophagus during Nissen fundoplication is associated with high morbidity and mortality when there is a delay in detection. The tech- nique of gastric insufflation after LNF effectively evalu- ates the integrity of the GE wall and should allow better intraoperative detection of injuries. Gastric insufflation technique appears to be a useful adjunct to laparoscopic foregut surgery. References: 1. Perdikis G, Hinder RA, Lund RJ, Raiser F, Katada N. Laparoscopic Nissen fundoplication: Where do we stand? Surg Lap Endosc. 1997;7(1):17-21. 2. Schauer PR, Meyers WC, Eubanks S, et al. Mechanisms of gastric and esophageal perforations during laparoscopic Nissen fundoplication. Ann Surg. 1996;223(1):43-52. 3. Lowham AS, Filipi CJ, Hinder RA, et al. Mechanisms and avoidance of esophageal perforations by anesthesia personnel during laparoscopic Nissen fundoplication. Surg Endosc. 1996;10:979-982. 4. Watson DI, Jamieson GG, Baigrie RJ, et al. Laparoscopic surgery for gastro-esophageal reflux: beyond the learning curve. BritJ Surg. 1996;83:1284-1287. 5. Collet D, Cadiere GB. Conversions and complications of laparoscopic treatment of gastroesophageal reflux disease. Am J Surg. 1995;l69:622-626. Acknowledgement: the authors wish to acknowledge the techni- cal support of Perlinda Uentillie, CST (Chinle Hospital, Navajo Nation) and Kimberly Keyser, R. Ph. (Ethicon Endo-Surgery, Cincinnati, OH). JSLS (1999)3:267-271 271