Introduction Until now it has been limited knowledge related to the application of high resolution manometry(HRM) for the evaluation of fundoplication results. The aim of this study is to assess prospectively esophagogastric junction(EGJ) relaxation and resting pressures and esophageal motility by HRM in patients with gastroesophageal reflux disease(GERD) before and after laparoscopic Nissen fundoplication.
Methods 25 patients with GERD(15 females; mean age 46.8 ) underwent HRM before(preoperative group) and at least 3 months after surgery(postoperative group). Manometric protocol included 10 consecutive swallows of 10 ml of water. Variables from pre and postoperative group were compared using Wilcoxon test for paired samples and also McNemar’s test was done to evaluate if surgery had influenced values normalisation.
Results In postoperative group mean basal EGJ pressure as well as minimal basal EGJ pressure were significantly higher than in preoperative group. Integrated relaxation pressure(IRP) was also significantly higher in postoperative group as compared with preoperative group. IRP values were within the normal range in both examined groups(<15 mmHg) except one patient in postoperative group. Before fundoplication 11 patients had hiatal hernia, but none after surgery. Significant increase of intrabolus pressure(IBP) and decrease of contractile front velocity(CFV) were found in postoperative group as compared with preoperative group. Distal contractile integral(DCI) was significantly higher in postoperative group, however based on DCI threshold(450mmHgxsxcm) only trend from ineffective to effective esophageal motility was observed(p = 0.07). Also double-peaked waves were more frequent in postoperative than in preoperative group. Early dysphagia was observed in 8 of 25 patients after fundoplication. Data is shown in table.
Conclusion HRM is valuable tool for EGJ characteristics in GERD patients before and after fundoplication. Fundoplication establishes antireflux barrier by increasing EGJ resting pressures and correcting hiatal hernia. Even moderate increased of IRP may contribute to motility disorders and bolus pressurisation in some patients after fundoplication.
Disclosure of Interest None Declared
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