Abstracts
2002 Digestive Disease Week

# 100396 Abstract ID: 100396 Fundoplication Improves Disordered Esophageal Motility
T R Heider, Kevin E Behrns, Mark J Koruda, Nicholas Shaheen, Tananchai Lucktong, Barbara Bradshaw, Timothy M Farrell, Chapel Hill, NC

Introduction: Many surgeons choose partial fundoplication over complete fundoplication for patients with gastroesophageal reflux disease (GERD) and disordered esophageal motility due to concerns about postoperative dysphagia. However, partial fundoplication may be less effective in preventing esophageal acid exposure. In a recently administered GERD-specific symptom survey, post-fundoplication dysphagia rates were low irrespective of preoperative esophageal motility. It is uncertain whether elimination of GERD by fundoplication results in recovery of esophageal motor function. Aim: To determine if disordered esophageal motility improves after fundoplication. Methods: Forty-eight of 262 patients who underwent laparoscopic fundoplication between 1995 and 2000 had preoperative manometric criteria for disordered esophageal motility (distal esophageal peristaltic amplitude 30mmHg or peristaltic frequency 80%). Of these, 19 (9 males, mean age 52.2 12.4 years) had preoperative manometric assessment at our facility and consented to re-study. Fifteen (79%) had undergone complete fundoplication and 4 (21%) partial fundoplication. Each patient underwent repeat four-channel esophageal manometry at a mean of 29.5 18.4 months after fundoplication. Distal esophageal peristaltic amplitude and peristaltic frequency were compared to matched preoperative data by paired t-test. Results: After fundoplication, mean peristaltic amplitude in the distal esophagus increased by 47% (56.8 30.9mmHg preoperative to 83.5 36.5mmHg postoperative, p<0.001) and peristaltic frequency improved by 33% (66.4 28.7% preoperative to 87.6 16.3% postoperative, p<0.01). Esophageal motor function recovered to normal range in 14 patients (74%) after fundoplication, whereas 5 patients' manometry status remained abnormal (2 improved, 1 worsened, 2 were unchanged). Three patients with preoperative peristaltic frequencies of 0%, 10% and 20% improved to 84%, 88% and 50% respectively after fundoplication. Changes in postoperative motility did not differ with respect to type of fundoplication. Conclusion: Fundoplication improves the amplitude and frequency of esophageal peristalsis in most GERD patients with disordered esophageal motility. Refluxate appears to have an etiologic role. Surgeons who apply partial fundoplication over complete fundoplication to protect against postoperative dysphagia must consider the impact of persistent esophageal acid exposure on recovery of esophageal motor function.