|
Back to 2014 Annual Meeting Posters
Intraoperative High Resolution Manometry to Calibrate Laparoscopic Nissen Fundoplication. Comparative Analysis With Standard Bougie Calibration
María Elia PéRez-Aguire*, María Inmaculada Dominguez, AndréS SáNchez-Pernaute, Antonio Ruiz De Leon, Antonio J. Torres
Hospital Clínico San Carlos, Madrid, Spain
Aim. To analyze manometric changes of the lower esophageal sphincter (LES) during laparoscopic Nissen fundoplication (LNF). To compare the functional results of intraoperative calibration with high resolution manometry (HRM) with those after standard bougie calibration.
Method. Ten patiens submitted to LNF were intraoperatively calibrated both with Maloney bougie and with HRM to obtain the reference pressure values to tailor HRM calibration. 44 patients were randomized to HRM calibration or standard calibration. In the first group, a HRM catheter was introduced preoperatively. All LES pressure and length values were recorded in the different phases of the operation, and both crural closure and fundoplication were tailored with after previously measured values. In the second group intraoperative calibration of crural closure and fundoplication was performed with an intraluminal 52 - 60 French Maloney bougie. All patients were submitted to a functional esophageal study one year after the operation. The study was approved by the Institutional Ethics Committee.
Results. There were no preoperative differences between both groups in pHmetric of manometric parameters. Patients submitted to HRM calibration showed an increase in mean LES pressure from 7.21 mm Hg before starting the operation, to 9.94 mm Hg after introducing CO2 pneumoperitoneum, 16 mm Hg after crural closure, 24 mm Hg after fundoplication and 25.73 mm Hg at the end of the operation and CO2 evacuation. The initial mean LES length was 3.15 cm, 3.7 cm after CO2 introduction, 5.1 cm after crural closure, 4.88 cm after fundoplication completion and 4.48 cm after CO2 evacuation, for a total mean increase of 1.33 cm.
At one year from the operation, patients submitted to HRM calibration had a better pHmetric result with a mean DeMeester's score of 8.24 vs 23.05 (p = 0.039) and a mean acid exposure of 1.57% vs 5.7% (p = 0.017). Mean LES pressure was slightly higher for HRM calibrated patients, 12.04 vs 11.12 mm Hg, p = 0.04, as well as total LES length. 3.97 cm vs 3.48 cm, p = 0.4, and intraabdominal LES length, 2.5 vs 1.9 cm, p = 0.2.
Conclusions. Intraoperative calibration of LNF with HRM gets better functional results than standard calibration using intraesophageal bougie. Both reflux control and pressure and length of LES are better when calibration is performed with HRM.
Back to 2014 Annual Meeting Posters
|
