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Fundoplication improves disordered esophageal motility.

T Ryan Heider1, Kevin E Behrns, Mark J Koruda

  • 1Division of Gastrointestinal Surgery and Digestive Diseases, Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7210, USA.

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract
|February 26, 2003
PubMed
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Fundoplication surgery improves esophageal motility in patients with gastroesophageal reflux disease (GERD) and abnormal esophageal function. This suggests acid reflux may cause motor dysfunction, supporting the use of complete fundoplication for these patients.

Area of Science:

  • Gastroenterology
  • Surgical Innovation
  • Esophageal Physiology

Background:

  • Gastroesophageal reflux disease (GERD) patients with esophageal dysmotility face risks of postoperative dysphagia.
  • Partial fundoplication is used to mitigate swallowing difficulties, while complete fundoplication offers potentially more durable reflux control.
  • Previous findings indicated dysphagia is uncommon post-fundoplication, irrespective of preoperative motility or procedure type.

Purpose of the Study:

  • To assess if esophageal function improves after fundoplication in patients with pre-existing esophageal dysmotility.
  • To evaluate changes in esophageal peristaltic amplitude and frequency post-surgery.
  • To determine the impact of fundoplication on overall esophageal motor function.

Main Methods:

Related Experiment Videos

  • Retrospective analysis of 48 GERD patients with disordered esophageal motility undergoing laparoscopic fundoplication (1995-2000).
  • Preoperative and postoperative esophageal manometry performed on 19 patients (mean follow-up 29.5 months).
  • Comparison of distal esophageal peristaltic amplitude and frequency before and after fundoplication using paired t-tests.

    • Main Results:

    • Mean distal esophageal peristaltic amplitude increased by 47% (P < 0.001) and frequency improved by 33% (P < 0.01) post-fundoplication.
    • 74% of patients exhibited normal esophageal motor function after surgery; 5 remained abnormal (2 improved, 1 worsened, 2 unchanged).
    • Significant improvements were noted even in patients with severely impaired preoperative peristaltic frequencies.

    Conclusions:

    • Fundoplication appears to enhance esophageal peristaltic amplitude and frequency in GERD patients with dysmotility.
    • These findings suggest that acid reflux may play a role in causing esophageal motor dysfunction.
    • Complete fundoplication should be considered for GERD patients with preoperative esophageal dysmotility, given improved motility and low rates of dysphagia.