Skip to main content
SpringerLink
Log in

Total fundoplication controls acid and nonacid reflux: evaluation by pre- and postoperative 24-h pH–multichannel intraluminal impedance

  • New Technology
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Studies have demonstrated that Nissen fundoplication controls acid gastroesophageal reflux (GER). Combined 24-h pH and multichannel intraluminal impedance (MII-pH) allows detection of both acid and nonacid GER. Antireflux surgery is considered for any patient whose medical therapy is not efficient, particularly patients with nonacid gastroesophageal reflux disease (GERD). Nevertheless, fundoplication used to control nonacid reflux has not been reported to date.

Methods

In this study, 15 consecutive patients who underwent laparoscopic Nissen-Rossetti fundoplication had MII-pH both before and after the surgical procedure. The numbers of acid and nonacid GER episodes were calculated with the patient in both upright and recumbent positions.

Results

The 24-h pH monitoring confirmed the postoperative reduction of exposure to acid (p < 0.05). Postoperatively, the total, acid, and nonacid numbers of GER episodes were reduced (p < 0.05).

Conclusion

According to the findings, MII-pH is feasible and well tolerated. It provides an objective means for evaluating the effectiveness of Nissen-Rossetti fundoplication in controlling both acid and nonacid GER.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. del Genio A, Maffettone V, Izzo G (1991) Intraoperative esophageal manometry. Minerva Chir 46:201–210

    PubMed  Google Scholar 

  2. Zentilin P, Iiritano E, Dulbecco P, Giannini E, Savarino V (2006) Normal values of 24-h ambulatory intraluminal impedance combined with pH-metry in subjects eating a Mediterranean diet. Dig Liver Dis 38:226–232

    Article  PubMed  CAS  Google Scholar 

  3. Shay S, Tutuian R, Sifrim D, Vela M, Wise J, Balaji N, Zhang X, Adhami T, Murray J, Peters J, Castell D (2004) Twenty-four-hour ambulatory simultaneous impedance and pH monitoring: a multicenter report of normal values from 60 healthy volunteers. Am J Gastroenterol 99:1037–1043

    Article  PubMed  Google Scholar 

  4. Mainie I, Tutuian R, Shay S, Vela M, Zhang X, Sifrim D, Castell DO (2006) Acid and nonacid reflux in patients with persistent symptoms despite acid suppressive therapy: a multicentre study using combined ambulatory impedance-pH monitoring. Gut 55:1398–1402

    Article  PubMed  CAS  Google Scholar 

  5. Roman S, Poncet G, Serraj I, Zerbib F, Boulez J, Mion F (2007) Characterization of reflux events after fundoplication using combined impedance-pH recording. Br J Surg 94:48–52

    Article  PubMed  CAS  Google Scholar 

  6. Gruebel C, Linke G, Tutuian R, Hebbard G, Zerz A, Meyenberger C, Borovicka J (2007) Prospective study examining the impact of multichannel intraluminal impedance on antireflux surgery. Surg Endosc 22:1241–1247

    Article  Google Scholar 

  7. del Genio G, Rossetti G, Brusciano L, Limongelli P, Pizza F, Tolone S, Fei L, Maffettone V, Napolitano V, del Genio A (2007) Laparoscopic Nissen-Rossetti fundoplication with routine use of intraoperative endoscopy and manometry: technical aspects of a standardized technique. World J Surg 31:1099–1106

    Article  PubMed  Google Scholar 

  8. Wiener GJ, Richter JE, Copper JB, Wu WC, Castell DO (1988) The symptom index: a clinically important parameter of ambulatory 24-hour esophageal pH monitoring. Am J Gastroenterol 83:358–361

    PubMed  CAS  Google Scholar 

  9. DeMeester TR, Johnson LF (1975) Evaluation of the Nissen antireflux procedure by esophageal manometry and twenty-four-hour pH monitoring. Am J Surg 129:94–100

    Article  PubMed  CAS  Google Scholar 

  10. Bahmeriz F, Dutta S, Allen CJ, Pottruff CG, Anvari M (2003) Does laparoscopic antireflux surgery prevent the occurrence of transient lower esophageal sphincter relaxation? Surg Endosc 17:1050–1054

    Article  PubMed  CAS  Google Scholar 

  11. Okholm M, Sorensen H, Wallin L, Boesby S (1999) Bile reflux into the esophagus: Bilitec 2000 measurements in normal subjects and in patients after Nissen fundoplication. Scand J Gastroenterol 34:653–657

    Article  PubMed  CAS  Google Scholar 

  12. Mainie I, Castell DO (2006) Do we need to rethink fundoplication for patients who have failed proton pump inhibitor therapy? Nat Clin Pract Gastroenterol Hepatol 3:2–3

    Article  PubMed  Google Scholar 

  13. Roman S, Bruley des Varannes S, Pouderoux P, Chaput U, Mion F, Galmiche JP, Zerbib F Consortium de Recherche Indépendant sur le Traitement et l’Exploration du Reflux gastro-oesophagien et de l’Endobrachyoesophage (CRITERE) (2006) Ambulatory 24-h esophageal impedance-pH recordings: reliability of automatic analysis for gastro-oesophageal reflux assessment. Neurogastroenterol Motil 18:978–986

    Google Scholar 

Download references

Acknowledgments

Special thanks go to Susanna Capasso (Biologist, Medimar) for her continuous technical support and to the continuous work of Vincenzo Maffettone, M.D., PhD, Vincenzo Napolitano, M.D., PhD, Federica Russo, M.D., and Maria Di Martino, M.D., in collecting the data and daily assisting the patients.

Author information

Authors and Affiliations

  1. First Division of General and Gastrointestinal Surgery, Second University of Naples, via Pansini, 5, 80131, Naples, Italy

    Gianmattia del Genio, Salvatore Tolone, Federica del Genio, Gianluca Rossetti, Luigi Brusciano, Francesco Pizza, Landino Fei & Alberto del Genio

Authors
  1. Gianmattia del Genio
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Salvatore Tolone
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Federica del Genio
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gianluca Rossetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Luigi Brusciano
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Francesco Pizza
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Landino Fei
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Alberto del Genio
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gianmattia del Genio.

Rights and permissions

Reprints and permissions

About this article

Cite this article

del Genio, G., Tolone, S., del Genio, F. et al. Total fundoplication controls acid and nonacid reflux: evaluation by pre- and postoperative 24-h pH–multichannel intraluminal impedance. Surg Endosc 22, 2518–2523 (2008). https://doi.org/10.1007/s00464-008-9958-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-008-9958-0

Keywords

Search

Navigation