BACKGROUND: The value of esophageal manometry and ambulatory pH monitoring before laparoscopic antireflux surgery (LARS) has been questioned because tailoring the operation to the degree of hypomotility often is not required. This study evaluated a consecutive cohort of patients referred for esophageal function studies in preparation for LARS to determine the rates of findings that would alter surgical decisions. METHODS: High-resolution manometry (HRM) was performed for each subject using a 21-lumen water-perfused system, and motor function was characterized. Gastroesophageal reflux disease (GERD) was evident from ambulatory pH monitoring if thresholds for acid exposure time and/or positive symptom association probability were passed. RESULTS: Of 1,081 subjects (age, 48.4 ± 0.4 years; 56.7% female) undergoing preoperative HRM, 723 (66.9%) also had ambulatory pH testing performed. Lower esophageal sphincter (LES) hypotension (38.9%) and nonspecific spastic disorder (NSSD) of the esophageal body (36.1%) were common. Obstructive LES pathophysiology was noted in 2.5% (achalasia in 1%; incomplete LES relaxation in 1.5%), and significant esophageal body hypomotility in 4.5% (aperistalsis in 3.2%; severe hypomotility in 1.3%) of the subjects. Evidence of GERD was absent in 23.9% of the subjects. Spastic disorders were more frequent in the absence of GERD (43.9% vs. 23.1% with GERD; p < 0.0001), whereas hypomotility and normal patterns were more common with GERD. CONCLUSIONS: Findings considered absolute or relative contraindications for standard 360º fundoplication are detected in 1 of 14 patients receiving preoperative HRM. Additionally, spastic findings associated with persistent postoperative symptoms are detected at esophageal function testing that could be used in preoperative counseling and candidate selection. Physiologic testing remains important in the preoperative evaluation of patients being considered for LARS.
BACKGROUND: The value of esophageal manometry and ambulatory pH monitoring before laparoscopic antireflux surgery (LARS) has been questioned because tailoring the operation to the degree of hypomotility often is not required. This study evaluated a consecutive cohort of patients referred for esophageal function studies in preparation for LARS to determine the rates of findings that would alter surgical decisions. METHODS: High-resolution manometry (HRM) was performed for each subject using a 21-lumen water-perfused system, and motor function was characterized. Gastroesophageal reflux disease (GERD) was evident from ambulatory pH monitoring if thresholds for acid exposure time and/or positive symptom association probability were passed. RESULTS: Of 1,081 subjects (age, 48.4 ± 0.4 years; 56.7% female) undergoing preoperative HRM, 723 (66.9%) also had ambulatory pH testing performed. Lower esophageal sphincter (LES) hypotension (38.9%) and nonspecific spastic disorder (NSSD) of the esophageal body (36.1%) were common. Obstructive LES pathophysiology was noted in 2.5% (achalasia in 1%; incomplete LES relaxation in 1.5%), and significant esophageal body hypomotility in 4.5% (aperistalsis in 3.2%; severe hypomotility in 1.3%) of the subjects. Evidence of GERD was absent in 23.9% of the subjects. Spastic disorders were more frequent in the absence of GERD (43.9% vs. 23.1% with GERD; p < 0.0001), whereas hypomotility and normal patterns were more common with GERD. CONCLUSIONS: Findings considered absolute or relative contraindications for standard 360º fundoplication are detected in 1 of 14 patients receiving preoperative HRM. Additionally, spastic findings associated with persistent postoperative symptoms are detected at esophageal function testing that could be used in preoperative counseling and candidate selection. Physiologic testing remains important in the preoperative evaluation of patients being considered for LARS.
Authors: G M Campos; J H Peters; T R DeMeester; S Oberg; P F Crookes; S Tan; S R DeMeester; J A Hagen; C G Bremner Journal: J Gastrointest Surg Date: 1999 May-Jun Impact factor: 3.452
Authors: M G Patti; M Arcerito; A Tamburini; U Diener; C V Feo; B Safadi; P Fisichella; L W Way Journal: J Gastrointest Surg Date: 2000 Mar-Apr Impact factor: 3.452
Authors: E R Winslow; R E Clouse; K M Desai; P Frisella; T Gunsberger; N J Soper; M E Klingensmith Journal: Surg Endosc Date: 2003-03-07 Impact factor: 4.584
Authors: Alexander Klaus; Michael Gadenstaetter; Gilbert Mühlmann; Werner Kirchmayr; Christoph Profanter; Sami R Achem; Gerold J Wetscher Journal: Dig Dis Sci Date: 2003-09 Impact factor: 3.199
Authors: Ishita Dhawan; Brendon O'Connell; Amit Patel; Ron Schey; Henry P Parkman; Frank Friedenberg Journal: Dig Dis Sci Date: 2018-12 Impact factor: 3.199
Authors: V M Kushnir; A Sathyamurthy; J Drapekin; S Gaddam; G S Sayuk; C P Gyawali Journal: Aliment Pharmacol Ther Date: 2012-03-20 Impact factor: 8.171
Authors: Anisa Shaker; Nathaniel Stoikes; Jesse Drapekin; Vladimir Kushnir; L Michael Brunt; C Prakash Gyawali Journal: Am J Gastroenterol Date: 2013-09-10 Impact factor: 10.864