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Oesophageal motility before and after laparoscopic Nissen fundoplication
G Mathew1, D I Watson, J C Myers
1Royal Adelaide Centre for Endoscopic Surgery, University Department of Surgery, Australia.
Background:
Whilst oesophageal manometry outcomes following fundoplication performed by open techniques have been described, detailed reports of changes in manometric parameters following large series of laparoscopic Nissen fundoplication have yet to be described.
Methods:
An analysis of oesophageal manometry studies performed on patients undergoing laparoscopic Nissen fundoplication at the Royal Adelaide Hospital was performed to quantitate the effect of surgery and to determine whether manometric indicators of adverse surgical outcome could be identified. The original manometric recordings from a subset of 103 patients were reviewed. Only patients who had undergone preoperative and postoperative examinations in this department, and assessment by an independent investigator using a standardized clinical questionnaire, were included in the study.
Results:
Mean resting lower oesophageal sphincter (LOS) pressure increased from 8.5 to 21.5 mmHg (P < 0.0001) following surgery, the mean residual pressure after sphincter relaxation (residual relaxation pressure) increased from 1.2 to 10.8 mmHg (P < 0.0001), and oesophageal 'ramp' pressure increased from 10.5 to 20.5 mmHg (P < 0.0001). Before operation 88 patients (85 per cent) propagated seven or more of ten wet swallows (normal peristalsis) versus 83 (81 per cent) after operation. Of the 15 patients with abnormal peristalsis before surgery, eight regained normal peristalsis after operation, whereas 13 of 88 patients with normal preoperative peristalsis subsequently had defective postoperative peristalsis. Raised postoperative residual relaxation pressure (r = 0.20) but not LOS pressure correlated significantly with postoperative dysphagia for liquids. None of the measured manometric parameters correlated with adverse outcomes such as postoperative dysphagia for solids, patient dissatisfaction or gas bloat.
Conclusion:
Whilst this study documents significant changes in LOS pressure following laparoscopic Nissen fundoplication, a clinically significant correlation between manometric outcome and clinical outcome was not demonstrated.