High Resolution Manometry in a Functioning Fundoplication - Establishing a Standard Profile: Retrospective Chart...

Area of Science:

• Gastroenterology
• Surgical Innovation
• Diagnostic Tools

Background:

• The Chicago classification guides interpretation of high-resolution manometry (HRM) in swallowing disorders.
• Limited data exists on HRM values post-fundoplication, necessitating further investigation.

Purpose of the Study:

• To establish a comprehensive HRM dataset for patients with normally functioning fundoplications.
• To define a new manometric profile for successful fundoplication outcomes.

Main Methods:

• Identified patients with pre- and postoperative HRM and successful primary fundoplication.
• Defined successful fundoplication by symptom resolution, absence of dysphagia, and normal esophageal acid exposure.
• Analyzed Lower Esophageal Sphincter (LES) parameters including integrated relaxation pressure (IRP).

Main Results:

• Fifty patients met inclusion criteria; 33 had complete and 17 partial fundoplications.
• Postoperative HRM showed significantly increased LES values (median IRP 14 mm Hg, median resting pressure 19.5 mm Hg).
• The 95th percentile for IRP was 29 mm Hg in complete and 23 mm Hg in partial fundoplications.

Conclusions:

• A new HRM profile for normally functioning fundoplications is proposed.
• The previous upper limit for esophageal outflow obstruction (IRP >20 mm Hg) is not applicable post-fundoplication.
• No significant difference in HRM LES values was observed between complete and partial fundoplications.