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Prognostic value of esophageal manometry in antireflux surgery in childhood
F Cullu1, F Gottrand, M D Lamblin
1Department of Pediatric Gastroenterology, Claude Huriez Hospital, Lille, France.
Insights
Preoperative esophageal manometry showed no predictive value for antireflux surgery outcomes in children. Further research is needed to understand GER mechanisms, especially in congenital esophageal abnormalities.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Diagnostic Medicine
Background:
- Gastroesophageal reflux (GER) is a common condition in children requiring surgical intervention.
- Antireflux surgery aims to correct the anatomical or functional defects causing GER.
- Predicting surgical outcomes is crucial for patient management and surgical planning.
Purpose of the Study:
- To evaluate the predictive capability of preoperative esophageal manometry in determining the success of antireflux surgery in pediatric patients.
- To identify potential factors influencing functional complications post-antireflux surgery.
Main Methods:
- Retrospective analysis of 14 children with severe GER who underwent antireflux surgery.
- Preoperative assessments included extended esophageal pH monitoring, barium swallow, and esophageal manometry.
- Patients were followed for 4 months to 4 years post-surgery, with a focus on functional complications.
Main Results:
- All patients had normal upper esophageal sphincter pressure (UESp).
- Reduced resting lower esophageal sphincter pressure (LESp) was observed in 4 patients; 7 had esophageal body motility issues.
- Only 2 patients experienced functional complications, with no clear correlation to manometry findings. Notably, patients with abnormal preoperative manometry had no complications.
Conclusions:
- Esophageal manometry does not appear to predict antireflux surgery outcomes in this pediatric cohort.
- Further investigation into GER mechanisms, particularly in cases of congenital esophageal abnormalities like esophageal atresia, is warranted.
Abstract:
To assess the predictive value of preoperative esophageal manometric study in the outcome of antireflux surgery, 14 children with severe gastroesophageal reflux (GER) who underwent surgery were studied retrospectively. Five patients had neuromuscular disease; one had been operated on for esophageal atresia. After extended (> 20 h) esophageal pH monitoring and/or barium swallow study, all patients underwent preoperative manometric study. After surgery, the patients were followed for 4 months to 4 years. Functional complications were noted after mechanical complications were eliminated. All patients had normal upper esophageal sphincter pressure (UESp); the resting lower esophageal sphincter pressure (LESp) was decreased in four patients, and seven had esophageal body motility trouble. Functional complications occurred in two patients. One was a neurologically involved patient who had had a normal preoperative manometric study; the other was the patient who had been operated on for esophageal atresia. No complications occurred in four patients who had had abnormal preoperative manometric studies. We conclude that, in this group of patients, esophageal manometric study has no predictive value in the outcome of the surgical procedure; however, it still would be interesting to elucidate the mechanisms of GER, especially in congenital abnormalities such as esophageal atresia.