Late complications after antireflux procedures using intraoperative continuous computer-video manometry monitoring

Gastroesophageal Reflux Disease (GERD) is a common non-malignant gastrointestinal disease. The introduction of minimally invasive surgical techniques and the high costs of pharmacotherapy increased the number of patients subjected to surgical antireflux treatment. Furthermore, the use of advanced technique of manometry--including intraoperative video-assisted continuous pressure monitoring--made possible complicated but objective analysis of the pressure profile in the newly created area of gastroesophageal junction.

The current study was conducted in 159 patients. A group consisted of 93 men and 66 women, mean age of 38 years (range 18-72), subjected to antireflux surgery with continuous intraoperative video-assisted manometry of pressure in the newly created gastroesophageal junction (fundoplication wrap). Surgical procedure was individually tailored in each case depending on the motility parameters and GERD etiology. Eighty seven patients (55%) underwent 360 degrees Nissen fundoplication, 17 "floppy" Nissen procedure (11%), 22 Dor hemifundoplication (14%), and 33 Toupet hemifundoplication (21%).

Out of the 159 patients subjected to antireflux procedures only 8 (5.0%) developed dysphagia, and 12 (7.5%) recurrent reflux disease. Recurrent reflux symptoms were most frequently caused by the dislocation of the fundoplication wrap. Dysphagia occurred in patients with too tight fundoplication wrap or because of its dislocation with subsequent rotation and angulation that impaired food passage. In some patients objective causes of dysphagia have not been found. In these patients no abnormalities were detected by the postoperative visualising examinations, and mean pressure in the fundoplication wrap did not exceed critical values. In these cases, dysphagia was caused probably by impaired gastric motility.

1. GERD with multifactor etiology requires individually tailored surgery based on the results of motility studies. 2. Final result depends on appropriate calculations of the intraoperative pressure in the newly created fundoplication wrap. 3. Appropriate fixing of the fundoplication wrap to the diaphragm is very important in order to decrease the rate of GERD recurrences due to wrap dislocation.