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High Resolution Manometry Guidance During Laparoscopic Fundoplication in Pediatric Surgically "Fragile" Patients:
Anna Maria Caruso1, Mario Milazzo1, Vincenzo Tulone1
1Pediatric Surgery Unit, Children's Hospital, ARNAS Civico-Di Cristina-Benfratelli, 90127 Palermo, Italy.
Insights
Intraoperative high-resolution manometry (HRM) during laparoscopic antireflux surgery in children with neurological impairment or esophageal atresia is feasible. This technique may optimize esophageal pressure changes and reduce GER relapses.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Devices
Background:
- High-resolution manometry (HRM) assesses esophageal intraluminal pressure and motor function.
- Intraoperative esophageal HRM is a novel technique during antireflux laparoscopic procedures.
- Feasibility and usefulness were evaluated in pediatric cases with neurological impairment (NI) or esophageal atresia (EA).
Purpose of the Study:
- To evaluate the feasibility and usefulness of intraoperative esophageal HRM.
- To assess esophageal pressure changes during laparoscopic antireflux surgery.
- To analyze outcomes in pediatric patients with NI or EA and gastroesophageal reflux (GER).
Main Methods:
- Seven children (5 NI, 2 EA) with GER underwent intraoperative esophageal HRM.
- Data collected included intraoperative esophagogastric junction (EGJ) pressure changes and postoperative follow-up.
- Analysis focused on pressure variations and surgical outcomes.
Main Results:
- All patients had a sliding hernia detected by EGJ double peak pressures.
- Hernia correction was successful in 71.4% of patients; 28.6% had residual hernia.
- Postoperative EGJ pressures were significantly higher than preoperative (p < 0.001), especially in NI patients (p = 0.05).
- No GER relapses occurred; two patients experienced postoperative dysphagia.
Conclusions:
- Intraoperative HRM may optimize esophageal pressure adjustments during laparoscopic fundoplication.
- This technique shows potential for tailoring surgical approaches.
- Further research is needed to confirm its utility in reducing postoperative complications.
Background:
High resolution manometry (HRM), has been recently introduced in clinical practice to detect esophageal intraluminal pressure and esophageal motor function. We evaluated the feasibility and usefulness of intraoperative esophageal HRM during antireflux laparoscopic procedures in pediatric cases with neurological impairment (NI) or esophageal atresia (EA).
Methods:
From January to November 2019, seven children (5 NI, 2 EA) with gastroesophageal reflux (GER) were enrolled. Data on intraoperative pressure changes of the esophagogastric junction (EGJ) and postoperative follow-up data were collected.
Results:
Average preoperative LES pressures were not significantly different from postoperative pressures. A sliding hernia was detected in all patients as evidenced by EGJ double peak pressures. Hernia correction after esophageal traction was complete in 71.4% of the patients, and residual hernia (<2 cm) was detected in 28.6%. Postoperative EGJ pressures were higher compared to preoperative sphincteric pressures (p < 0.001); in NI patients, higher postoperative values were noted compared to EA (p = 0.05). No sliding hernia and/or GER relapses were recorded. Two patients reported dysphagia postoperatively.
Conclusions:
Intraoperative HRM may optimize esophageal pressure changes during laparoscopic fundoplication. Further studies are needed to confirm the usefulness of a tailored surgical approach to reduce postoperative complications.
