title: Evaluation of the antireflux mechanism following laparoscopic fundoplication.
abstract: BACKGROUND
  Laparoscopic Nissen fundoplication is an effective procedure for the treatment of gastro-oesophageal reflux disease (GORD), but the underlying motility mechanisms that explain the success of this operation remain unclear.
  
  
  METHODS
  Twenty patients with a history of GORD underwent stationary oesophageal manometry and prolonged ambulatory pH monitoring, both before and 3 months after fundoplication.
  
  
  RESULTS
  Eighteen patients were completely cured of reflux symptoms and stopped all antireflux medication after operation. After fundoplication there was a significant increase (P < 0.01) in median resting lower oesophageal sphincter (LOS) pressure and length. Median residual LOS pressure during swallow-induced LOS relaxation also increased significantly after operation (P < 0.01). The number of reflux episodes decreased from a median of 48 to 3 after fundoplication (P < 0.01). The time at pH less than 4 decreased from 5.7 to 0 per cent in the supine position (P < 0.01), and from 9.8 to 0.2 per cent while upright (P < 0.001).
  
  
  CONCLUSIONS
  Early subjective results at 3 months following laparoscopic antireflux surgery show improved symptoms. One of the mechanisms underlying the antireflux action of fundoplication is an increase in median residual LOS pressure at the gastro-oesophageal junction. This may be a purely mechanical effect of the fundic wrap extrinsic to the LOS.
authors.affiliation: Department of Medicine, Graduate Hospital, Philadelphia, Pennsylvania, USA.
authors.forename: K G
authors.initials: KG
authors.lastname: Pursnani
authors.forename: D M
authors.initials: DM
authors.lastname: Sataloff
authors.forename: F
authors.initials: F
authors.lastname: Zayas
authors.forename: D O
authors.initials: DO
authors.lastname: Castell
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000503:physiopathology / Q000601:surgery*; D005769:Gastrointestinal Motility / Q000502:physiology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D010535:Laparoscopy; D008297:Male; D008365:Manometry; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D011300:Preoperative Care; D011312:Pressure; D016896:Treatment Outcome