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Comparative Manometric Characteristics of 3 Anti-Reflux Operations
Alia Qureshi*1, Ralph W. Aye1, Brian E. Louie1, Alexander S. Farivar1, Ariel Knight1, Lee L. Swanstrom2
1Swedish Medical Center, Seattle, WA; 2Legacy Health, Portland, OR
Background: The impact of antireflux operations on esophageal motility and lower esophageal sphincter characteristics is incompletely understood. Comparing the manometric features of various repairs may provide insight through differences and similarities.
Materials and methods: 153 patients with gastroesophageal reflux and/or hiatal hernia underwent one of 3 laparoscopic operations at 2 institutions through 1 of 2 IRB-approved prospective protocols evaluating Nissen fundoplication (NF), Hill repair (HR), or a combination of Nissen plus Hill hybrid repair (NH). Clinical and objective testing and quality of life metrics were administered preoperatively and at 6-12 month follow-up. Ninety patients underwent pre-and post-operative manometry (NF=27; HR=37; NH=26).
Results: Manometric results are listed in the table. Post-operative lower esophageal sphincter pressure (LESP) was increased significantly for NF and NH but not HR; residual LESP was highest in NF. DeMeester scores were equivalent, NF=6.58; HR=10.89, NH=7.3. Postoperative quality of life scores were equivalent, NF=6.24; HR=6.24; NH=6.69; Postoperative dysphagia scores were better for NH, 43.0 vs NF=37.2 and HR=38.1 (p=0.019). Postoperative medication use was less for NH, 2.4% vs NF=19.5% and HR=17.0%.
Conclusions: Combining NF and HR in one operation results in manometric lower esophageal sphincter characteristics that are similar to the individual component repairs, with low medication use and reduced long-term dysphagia. This suggests that there may be benefit to intra-abdominal fixation of the gastroesophageal junction Further study of the relative contributions of the fundoplication and the diaphragmatic repair are warranted.
Trivariate Manometric Comparisons
| Preoperative NF (N=46) | Preoperative HR (N=55) | Preoperative NH (N=43) | P value | Postoperative NF | Postoperative HR | Postoperative NH | p value | | Average LESP (mmHG) | 14.3 | 18.2 | 18.5 | 0.152 | 26.3 | 19.3 | 23.2 | 0.027 | | Average residual LESP (mmHg) | 4.6 | 9.48 | 4.6 | 0.059 | 14.7 | 8.5 | 11.1 | 0.042 | | Average mean distal amplitudes (mmHg) | 75.6 | 85.4 | 72.3 | 0.238 | 81.6 | 99.0 | 76.1 | 0.074 | | Peristalsis normal | 92% | 92% | 84% | | 79% | 87% | 77% | | | Peristalsis moderate dysfunction | 4% | 4% | 9% | | 7% | 8% | 23% | | | Peristalsis severe dysfunction | 4% | 4% | 7% | | 14% | 5% | 0% | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
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