Normal Lower Esophageal Sphincter Function Does Not Impact Outcome After Laparoscopic Nissen Fundoplication
Alexander S. Rosemurgy, Sam Al-Saadi, Desiree Villadolid, Sarah Cowgill; Surgery, University of South Florida, Tampa, FL
Introduction: Intuitively, a manometrically normal lower esophageal sphincter (LES) will promote dysphagia after laparoscopic Nissen Fundoplication, without improving reflux. This study was undertaken to compare outcomes after laparoscopic Nissen fundoplication for patients with GERD and normal vs. manometrically inadequate LES. Methods: Before fundoplication, the length and resting pressure of LES was determined manometrically in 66 patients with GERD. 32 patients had a manometrically normal LES, with resting pressure > 10 mmHg and length > 2 cm. 34 other patients had resting pressures of ≤ 10 mmHg and length of ≤ 2 cm. Patients also underwent a 24-hr ambulatory pH study. Before and after fundoplication, patients graded the frequency and severity of symptoms of GERD utilizing a Likert scale (0=never/not bothersome to 10=always/very bothersome). For each patient, symptom scores before vs. after fundoplication were compared using Wilcoxon matched pairs test. DeMeester scores and symptoms before and after fundoplication were compared between patients using Mann-Whitney U-test. Results: Before fundoplication, the LES function impacted neither the elevation of the DeMeester scores nor the frequency or severity of reflux symptoms (Table). All symptoms improved significantly with fundoplication independent of LES function (Table). Prefundoplication LES function did not impact the frequency or severity of reflux symptoms after fundoplication (Table). Conclusions: Patients suffering from GERD, normal LES function does not impact the presentation of GERD or the outcome after laparoscopic Nissen fundoplication. Symptoms globally and significantly improve after laparoscopic Nissen fundoplication independent of LES function. Normal LES function does not impact outcome after laparoscopic Nissen fundoplication. Laparoscopic Nissen fundoplication should be recommended for patients with GERD independent of LES function.
Symptoms Of Patients Before and After Laparoscopic Nissen Fundoplication
| | DeMeester Score | Chest Pain Frequency | Regurgitation Frequency | Choking Frequency | Heartburn Frequency | Heartburn Severity | Regurgitation Severity | Choking Severity | Chest Pain Severity | ||||||||
| Preop | Postop | Preop | Postop | Preop | Postop | Preop | Postop | Preop | Postop | Preop | Postop | Preop | Postop | Preop | Postop | ||
| Normal LES (n=32) | 38.0(43.2±30.2) | 8.0(5.4±4.0) | 2.0(3.8±3.6) | 6.0(6.4±3.2) | 0.0(2.4±3.4) | 2.0(3.6±3.6) | 0.0(1.8±3.0) | 8.0(6.8±3.0) | 2.0(2.6±3.4) | 8.0(6.7±3.4) | 1.0(2.0±3.0) | 7.0(6.2±3.3) | 1.0(1.9±2.7) | 6.0(5.5±4.0) | 1.0(2.4±3.5) | 3.5(4.0±4.0) | 0.0(1.6±2.6) |
| Inadequate LES (n=34) | 65.0(77.6±69.8) | 4.0(4.6±3.0) | 2.0(2.2±2.2) | 6.0(5.6±3.2) | 0.0(2.0±3.0) | 4.0(4.2±4.2) | 0.0(1.4±2.4) | 8.0(8.0±2.8) | 2.0(2.4±3.2) | 9.5(7.9±3.0) | 1.0(1.9±2.6) | 7.0(6.2±3.3) | 0.0(1.2±2.6) | 5.0(4.8±3.6) | 2.0(2.1±2.1) | 1.0(3.0±3.5) | 1.0(1.2±1.5) |
All preop vs postop were significantly different from Wilcoxon matched-pairs test. All preop vs preop and postop vs postop were not significantly different using Mann-Whitney U-test. Data Format Median(Mean±SD)
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