[Intraoperative manometry in laparoscopic antireflux procedures --indications, methods and clinical results]

The aim of the study is evaluating the efficiency of intraoperative manometry during laparoscopic Nissen fundoplication and its ability to prevent postoperative complications.

Sixteen patients with Gastroesophageal Reflux Disease were included in the study. Clinical examinations, x-ray, endoscopy, pH-metry, and manometric studies were performed before, and 3-6 m.o. after surgery. Fourteen patients were undergoing Nissen fundoplication, and two "floppy Nissen" fundoplications due to the specific preoperative manometric indications.

Postoperatively the mean proportion of time at pH < 4.0 on pH-metry decreased from 188 min. (range 96-263) to 8.5 min. (range 2-25). Mean number of reflux episodes significantly lowered after fundoplication from 18.9 (range 2-36) to 0.5 (range 0-3). Gastroesophageal junction mean pressure measured postoperatively reached 24.7 mmHg, and was significantly higher than preoperatively (8.9 mmHg). Mean length of LES increased from 1.2 cm (range 0.8-2.5) to 3.6 cm (range 2.4-4.6) postoperatively.

Laparoscopic Nissen fundoplication assisted by the simultaneous continuous intraoperative manometry is feasible and effective procedure. Continuous LES pressure monitoring during laparoscopic fundoplication with simultaneous computer-video assisted display can be advised as an objective method of intraoperative evaluation of antireflux mechanism.