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BACKGROUND
The Laparoscopic Nissen Fundoplication (LNF) and the Laparoscopic Hill Repair (LHR), in which the gastroesophageal junction is fixed to the preaortic fascia, were shown in a recent randomized trial to be equivalent in controlling uncomplicated GERD at 12 months. Manometrically, the LNF achieved a statistically significant increase in LES pressure; whereas, LHR did not. This study aims to further evaluate the post-operative high resolution manometry studies from this trial to determine if differences between the two repairs can explain the resultant GERD control.
METHODS
Of 46 LNF patients and 56 LHR patients who were randomized, there were 16 LNF patients and 20 LHR patients with available post-op manometric testing. High Resolution Manometry (HRM) was performed using the Manoscan system and analyzed using ManoView (V2.0) Software. Manometries were interpreted by a single clinician, blinded to the procedure performed using the Chicago classification.
RESULTS
The overall LES length among LNF and LHR groups was similar. (2.7 vs 2.3, p = 0.15). However, the mean intra-abdominal LES length after LNF was longer (1.8 vs 1.2, p = 0.047) than after LHR. The integrated relaxation pressures were also similar (11.7 vs 10.7, p = 0.54). The percent peristalsis was similar with 91% achieving 100% peristalsis with distal amplitudes of 91 and 89 mm Hg respectively. The distal contractile integral was 2299 compared to 2087 (p = 0.66).
DISCUSSION
Post-operative manometric analysis using high resolution manometry was unable to detect measurable differences between the LNF and LHR to explain how each repair results in GERD control. The difference in intraabdominal LES length likely reflects the difference in the anatomy of the gastroesophageal junction after reconstruction.