Abstracts
1997 Digestive Disease Week

Esophageal and lower esophageal motor function after laparoscopic Nissen fundoplication.

M Anvari, C Allen. Departments of Surgery and Medicine, St. Joseph's Hospital, McMaster University, Hamilton, Canada.

A significant number of patients undergoing anti-reflux surgery have mild to moderate esophageal motor abnormality. It has been suggested that anti-reflux surgery may cause an improvement in esophageal motor function. We evaluated esophageal and lower esophageal sphincter pressures with an eight-lumen sleeve/sidehole catheter in 374 patients with proven gastroesophageal reflux disease prior to undergoing laparoscopic Nissen fundoplication. The manometric evaluation was repeated in 236 patients at 6 months and in 87 patients at 2 years following the surgery.

Results are tabulated below. The proximal, mid and distal esophageal pressures, and the lower esophageal sphincter (LES) basal and nadir pressures are given in mmHg.

                         pre-op           6 months          2 years
                                           post-op          post-op
  LES pressure          6.79±0.27        20.92±0.69*      19.74±1.1*
  Nadir pressure        0.54±0.04         6.32±0.39*        6.1±0.55*
  Prox Esophagus        45.1±1.3          45.2±1.7         45.7±2.7
  Mid Esophagus         70.6±1.8          71.2±2.5         70.8±4.1
  Distal Esophagus      86.7±2.3          81.8±3.1         88.1±4.9
  % 1°peristalsis       87.8±1.0          81.2±1.8         82.2±3.0
  dysphagia             4.28±0.25         2.56±0.23*       1.72±0.29*
  symptom score
values are given as mean±SE, * p<0.05 cf preop values

There was a significant increase in LES basal and nadir pressure following surgery but no significant change in esophageal motor function. Lack of significant esophageal motor improvement after surgery fails to explain the improvement in dysphagia score reported after surgery. The data demonstrate that the fundoplication wrap can relax during swallowing although the nadir pressure was still significantly higher than seen in healthy individuals (<2mmHg). The lack of change in LES pressure between 6 and 24 month evaluations suggests that the anti-reflux function of the wrap is unchanged over this period of time, and that the surgery should have good long-term results.