Intraoperative Esophageal Manometry and Fundoplications: Prospective Study

Abstract

The purpose of this study was to validate the use of intraoperative manometry for assessing fundoplication and to search for predictive manometric criteria. This prospective study concerned 48 patients operated for gastroesophageal reflux. The manometry was carried out pre-and intraoperatively for all patients and postoperatively as well for 30 patients. The operative procedures were total fundoplication (n ‫؍‬ 25) and posterior (partial) fundoplication (n ‫؍‬ 5). The lower esophageal sphincter (LES) pressures and lengths were similar in the preoperative and intraoperative measurements before any esophageal mobilization, whereas the intraoperative LES pressure was significantly higher after fundoplication. The mean postoperative LES pressure decreased by 50 ؎ 19% compared with the intraoperative pressure after fundoplication. The final intraoperative pressures of two dysphagic patients were not the highest of the study. More importantly, their final intraoperative pressures were 7.5 and 8.2 times the initial pressure, respectively, which was significantly greater than the intraoperative pressure increase of the nondysphagic patients (4.6 ؎ 2.0 times). The final intraoperative pressure of the only patient with recurrence (18.2 mmHg) was the lowest of the study. In conclusion, intraoperative manometry is an effective method for evaluating the LES, and it could have predictive value for the surgical management of gastroesophageal reflux disease.

Prognostic value of the lower esophageal sphincter gradient and acid exposure in the follow-up of antireflux operations *

“…20 Some authors have even determined an`arbitrary' level of LES resting pressure of 10 mmHg below which recurrence is likely to occur. 4,13,21 Our data are compatible with this hypothesis because the mean post-operative LES resting pressure was between 8.30 and 12.7 mmHg in the failure group.…”

“…In general, antireflux surgery using a fundoplication is responsible for an early post‐operative rise in the LES resting pressure, which is significantly increased when compared with preoperative values. There is no controversy about these changes in the literature 5 –16…”

Can intraoperative manometry during laparoscopic fundoplication predict postoperative dysphagia?

“…Numerous published studies have used intraoperative manometry in the formation of the fundoplication wrap [8,9], but no studies have used it for predicting postoperative dysphagia. Hill [10] performed intraoperative manometry for 200 patients with gastroesophageal reflux.…”

Outcome of floppy Nissen fundoplication with intraoperative manometry to treat sliding hiatal hernia

“…Since July 2001, we attempted to add intraoperative esophageal manometry to the floppy Nissen fundoplication to make more accurate and objective adjustments of the fundic wrap’s tightness and floppiness and reduce postoperative complications. Previous studies which used esophageal manometry for antireflux surgery emphasized the importance of LESP and neglected the role of LESL 14–16 . In fact, the ability of the LES to protect the esophageal mucosa from exposure to gastric juice depends on its resting pressure, length exposed to abdominal pressure, and overall length combined.…”

“…Previous studies which used esophageal manometry for antireflux surgery emphasized the importance of LESP and neglected the role of LESL. [14][15][16] In fact, the ability of the LES to protect the esophageal mucosa from exposure to gastric juice depends on its resting pressure, length exposed to abdominal pressure, and overall length combined. Mechanical incompetence of the sphincter can occur when one or more of these components fail.…”