Fundoplication improves disordered esophageal motility |
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Authors: | T Ryan Heider MD Kevin E Behrns MD Mark J Koruda MD Nicholas J Shaheen MD Tananchai A Lucktong MD Barbara Bradshaw RN Timothy M Farrell MD |
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Institution: | (1) Divisions of Gastrointestinal Surgery and Digestive Diseases and Nutrition, Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina;(2) Divisions of Gastrointestinal Surgery and Digestive Diseases and Nutrition, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina;(3) Department of Surgery, University of North Carolina at Chapel Hill, 27599-7210 Chapel Hill, NC |
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Abstract: | Patients with gastroesophageal reflux disease (GERD) and disordered esophageal motility are at risk for postoperative dysphagia,
and are often treated with partial (270-degree) fundoplication as a strategy to minimize postoperative swallowing difficulties.
Complete (360-degree) fundoplication, however, may provide more effective and durable reflux protection over time. Recently
we reported that postfundoplication dysphagia is uncommon, regardless of preoperative manometric status and type of fundoplication.
To determine whether esophageal function improves after fundoplication, we measured postoperative motility in patients in
whom disordered esophageal motility had been documented before fundoplication. Forty-eight of 262 patients who underwent laparoscopic
fundoplication between 1995 and 2000 satisfied preoperative manometric criteria for disordered esophageal motility (distal
esophageal peristaltic amplitude ≤30 mm Hg and/or peristaltic frequency ≤80%). Of these, 19 had preoperative manometric assessment
at our facility and consented to repeat study. Fifteen (79%) of these patients had a complete fun-doplication and four (21%)
had a partial fundoplication. Each patient underwent repeat four-channel esophageal manometry 29.5 ± 18.4 months (mean ± SD)
after fundoplication. Distal esophageal peristaltic amplitude and peristaltic frequency were compared to preoperative data
by paired t test. After fun-doplication, mean peristaltic amplitude in the distal esophagus increased by 47% (56.8 ± 30.9 mm Hg to 83.5
± 36.5 mm Hg; P < 0.001) and peristaltic frequency improved by 33% (66.4 ± 28.7% to 87.6 ± 16.3%; P< 0.01). Normal esophageal motor function was present in 14 patients (74%) after fundoplication, whereas in five patients
the esophageal motor function remained abnormal (2 improved, 1 worsened, and 2 remained unchanged). Three patients with preoperative
peristaltic frequencies of 0%, 10%, and 20% improved to 84%, 88%, and 50%, respectively, after fundoplication. In most GERD
patients with esophageal dysmotility, fundoplication improves the amplitude and frequency of esophageal peristalsis, suggesting
refluxate has an etiologic role in motor dysfunction. These data, along with prior data showing that postoperative dysphagia
is not common, imply that surgeons should apply complete fun-doplication liberally in patients with disordered preoperative
esophageal motility.
Presented at the Forty-Third Annual Meeting of The Society for Surgery of the Alimentary Tract, San Francisco, California,
May 19–22, 2002 (poster presentation). |
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Keywords: | Gastroesophageal reflux disease (GERD) fundoplication esophageal dysmotility dysphagia |
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