Effectiveness of intraoperative L.E.S. pressure measurement during Nissen-Rossetti fundoplication

A study was made to evaluate the effectiveness of Lower Esophageal Sphincter Pressure (L.E.S.P.) measurement during Nissen antireflux procedure. Thirty-five patients affected by reflux esophagitis were submitted preoperatively to X-ray examination, endoscopy and esophageal biopsy, intraluminal esophageal manometry and 24 hour pH monitoring of the distal esophagus. Intraoperative measurement of L.E.S.P. was performed before and after Nissen fundoplication. In 30 patients a follow-up (average 32 months after surgery) was performed by clinical, radiographic and pH (24 hour monitoring) evaluation. Complete relieve of symptoms was obtained in patients showing a L.E.S.P. between 25 and 30 mm Hg after fundoplication. Symptoms of "post-fundoplication syndrome" were observed in two subjects with a L.E.S.P. more than 30 mm Hg. On the other hand, one patient with sphincteric pressure of less than 25 mm Hg suffered from postoperative recurrence of gastroesophageal reflux. The effectiveness of intraoperative L.E.S.P. measurement to verify the adequacy of Nissen fundoplication is emphasized. It is also postulated that good results can be obtained when surgical repair is associated with a range of intraoperative sphincteric pressure between 25 and 30 mm Hg.