BACKGROUND: Transient lower esophageal sphincter relaxation (TLESR) is the most common mechanism underlying gastroesophageal reflux disease (GERD), causing 70% to 100% of the reflux episodes in normal subjects and 63% to 74% of the reflux episodes in patients with reflux disease. This study aimed to evaluate the effect of laparoscopic Nissen fundoplication on TLESR in patients with proven GERD. METHODS: We prospectively followed 73 consecutive patients (13 men and 60 women; mean age, 43.7 +/- 1.72 years) with proven diagnosis of GERD and reported TLESRs found during a 40-min esophageal manometric study. These patients had repeat testing 6 months after undergoing laparoscopic Nissen fundoplication. RESULTS: Laparoscopic Nissen fundoplication increased the basal and nadir lower esophageal sphincter (LES) pressure and significantly reduced the number of TLESRs during the manometric study. No patients after surgery exhibited TLESR with nadir less than 2 mmHg. However, 8 of the 73 patients (11%) exhibited TLESR to a nadir exceeding 50% of basal pressure (mean nadir, 5.0 +/- 1.07 mmHg). CONCLUSIONS: The number of TLESRs is reduced significantly by antireflux surgery. Even accounting for increased basal and nadir pressures, the incidence of TLESR is reduced, suggesting that there may be additional mechanisms involved in this process.
BACKGROUND: Transient lower esophageal sphincter relaxation (TLESR) is the most common mechanism underlying gastroesophageal reflux disease (GERD), causing 70% to 100% of the reflux episodes in normal subjects and 63% to 74% of the reflux episodes in patients with reflux disease. This study aimed to evaluate the effect of laparoscopic Nissen fundoplication on TLESR in patients with proven GERD. METHODS: We prospectively followed 73 consecutive patients (13 men and 60 women; mean age, 43.7 +/- 1.72 years) with proven diagnosis of GERD and reported TLESRs found during a 40-min esophageal manometric study. These patients had repeat testing 6 months after undergoing laparoscopic Nissen fundoplication. RESULTS: Laparoscopic Nissen fundoplication increased the basal and nadir lower esophageal sphincter (LES) pressure and significantly reduced the number of TLESRs during the manometric study. No patients after surgery exhibited TLESR with nadir less than 2 mmHg. However, 8 of the 73 patients (11%) exhibited TLESR to a nadir exceeding 50% of basal pressure (mean nadir, 5.0 +/- 1.07 mmHg). CONCLUSIONS: The number of TLESRs is reduced significantly by antireflux surgery. Even accounting for increased basal and nadir pressures, the incidence of TLESR is reduced, suggesting that there may be additional mechanisms involved in this process.
Authors: L Lundell; P Miettinen; H E Myrvold; S A Pedersen; B Liedman; J G Hatlebakk; R Julkonen; K Levander; J Carlsson; M Lamm; I Wiklund Journal: J Am Coll Surg Date: 2001-02 Impact factor: 6.113
Authors: Marco E Allaix; Piero M Fisichella; Imre Noth; Fernando A Herbella; Bernardo Borraez Segura; Marco G Patti Journal: J Gastrointest Surg Date: 2013-09-04 Impact factor: 3.452
Authors: Marco E Allaix; Fabrizio Rebecchi; Mario Morino; Francisco Schlottmann; Marco G Patti Journal: World J Surg Date: 2017-07 Impact factor: 3.352
Authors: Marco E Allaix; P Marco Fisichella; Imre Noth; Bernardino M Mendez; Marco G Patti Journal: J Gastrointest Surg Date: 2013-04-25 Impact factor: 3.452
Authors: Gianmattia del Genio; Salvatore Tolone; Federica del Genio; Gianluca Rossetti; Luigi Brusciano; Francesco Pizza; Landino Fei; Alberto del Genio Journal: Surg Endosc Date: 2008-05-14 Impact factor: 4.584