Can intraoperative manometry during laparoscopic fundoplication predict postoperative dysphagia?

Area of Science:

• Gastroenterology
• Surgical Innovation
• Esophageal Physiology

Background:

• Intraesophageal manometry (IEM) is used to assess fundoplication adequacy.
• Postfundoplication dysphagia is a common complication following surgery for gastroesophageal reflux disease (GERD).
• This pilot study investigated the predictive value of IEM for postoperative dysphagia.

Purpose of the Study:

• To evaluate the utility of intraesophageal manometry (IEM) in predicting postfundoplication dysphagia.
• To compare preoperative, intraoperative, and postoperative IEM findings with patient outcomes.

Main Methods:

• A cohort of 40 patients with GERD underwent preoperative IEM.
• Intraoperative IEM was performed at multiple stages: before pneumoperitoneum, after pneumoperitoneum, and after fundoplication.
• Postoperative IEM was conducted at 3 months, with follow-up at 1, 6, and 12 months for dysphagia and reflux assessment.

Main Results:

• Three patients experienced persistent dysphagia at 12 months.
• No significant preoperative IEM differences were found between dysphagic and non-dysphagic groups.
• Significant differences in lower esophageal sphincter pressures were observed intraoperatively, particularly after fundoplication with pneumoperitoneum (47.3 vs. 23.4 cm H2O; p = 0.001).
• Postoperative IEM at 3 months showed no statistically significant differences.

Conclusions:

• Intraoperative manometry appears more valuable than postoperative manometry for identifying patients at risk of postfundoplication dysphagia.
• IEM during surgery may aid in predicting and potentially preventing dysphagia after fundoplication.