title: Intraoperative esophageal manometry and early postoperative esophageal pH monitoring in children.
abstract: Intraoperative esophageal manometry has not been correlated with early postoperative extended esophageal pH monitoring (EEpHM) in children with gastroesophageal reflux. Twenty-seven children were studied with the following design: (1) abnormal preoperative EEpHM; (2) intraoperative measurement of lower esophageal high pressure zone (LEHPZ) pressure and length prior to and upon completion of an antireflux procedure; and (3) EEpHM seven to ten days postoperatively. Sixteen had a Nissen or modified Thal fundoplication and eleven a Boerema gastropexy. The postoperative EEpHM was normal in patients with fundoplication regardless of the increase in LEHPZ pressure (-4 to 36 mmHg) or length (0 to 2.5 cm). Four of the patients (36%) who had a gastropexy had abnormal EEpHM. The postoperative frequency of reflux was related inversely to the elevation of LEHPZ pressure (-3 to 39 mmHg), but not to the LEHPZ length (0 to 4.5 cm). Duration of reflux was independent of observed intraoperative manometric changes. In conclusion, early postoperative EEpHM in children having a gastropexy correlates with intraoperative increases in the LEHPZ pressure. There is no such correlation in children having a fundoplication procedure.
authors.affiliation: Department of Surgery, University of Oklahoma College of Medicine, Oklahoma City.
authors.forename: S G
authors.initials: SG
authors.lastname: Jolley
authors.forename: W P
authors.initials: WP
authors.lastname: Tunell
authors.forename: D J
authors.initials: DJ
authors.lastname: Hoelzer
authors.forename: E I
authors.initials: EI
authors.lastname: Smith
mesh_terms: D002648:Child; D002675:Child, Preschool; D004947:Esophagus / Q000503:physiopathology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007223:Infant; D007231:Infant, Newborn; D007432:Intraoperative Period; D008297:Male; D008365:Manometry; D008722:Methods; D008991:Monitoring, Physiologic; D011184:Postoperative Period