Effect of partial and total laparoscopic fundoplication on esophageal body motility |
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Authors: | F A M Herbella P Tedesco I Nipomnick P M Fisichella M G Patti |
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Institution: | (1) Department of Surgery, University of California San Francisco, San Francisco, CA, USA;(2) 521 Parnassus Ave, Room C-341, Box 0790, San Francisco, CA 94143-0790, USA |
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Abstract: | Background Abnormal esophageal body motility often accompanies gastroesophageal reflux disease (GERD). Although the effect of surgery
on the pressure and behavior of the lower esophageal sphincter (LES) has been extensively studied, it still is unclear whether
a successful fundoplication improves esophageal peristalsis.
Methods The pre- and postoperative esophageal manometries of 71 patients who underwent a successful laparoscopic fundoplication (postoperative
DeMeester score < 14.7) were reviewed. The patients were grouped according to the type of fundoplication (partial vs total)
and preoperative esophageal peristalsis (normal vs abnormal): group A (partial fundoplication and abnormal esophageal peristalsis;
n = 16), group B (total fundoplication and normal peristalsis; n = 41), and group C (total fundoplication and abnormal peristalsis; n = 14).
Results The LES pressure was increased in all the groups. A significant increase in amplitude of peristalsis was noted in groups A
and C. Normalization of peristalsis was achieved in 31% of the group A patients and 86% of the group C patients. No changes
occurred in group B.
Conclusions Laparoscopic fundoplication increased LES pressure and the strength of esophageal peristalsis in patients with abnormal preoperative
esophageal motility. A total fundoplication resulted in normalization of peristalsis in the majority of patients.
Presented at the Annual Meeting of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), Dallas, Texas,
27–29 April 2006 |
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Keywords: | Ambulatory pH monitoring Esophageal manometry Esophageal peristalsis Gastroesophageal reflux disease Laparoscopic fundoplication |
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