Prognostic value of the lower esophageal sphincter gradient and acid exposure in the follow-up of antireflux operations.
Eighty-eight consecutive patients with antireflux fundoplication had manometry and pH recording pre- and post-operatively at 6 months and 1, 3 and 5 years for a mean follow-up of 30.6 months. Failure occurred in nine patients (11.4%). For the whole group of patients, surgery produced a significant increase in the lower esophageal sphincter (LES) pressure gradient from 9.5 +/- 6.3 to 14.6 +/- 6.7 mmHg and a significant decrease in acid exposure from 20.6% +/- 17.6% to 5.5% +/- 8.8% at 6 months. There was a similar change in pressure (p < 0.0005) and pH (p < 0.002) in the successful but not in the failure group. Over time, the values remained stable in both groups. Post-operative LES pressure was significantly correlated with the outcome at 6 months (p < 0.02), and the pH was inversely correlated at 5 years (p < 0.039). This study confirms the early predictive value of the post-operative LES pressure. Esophageal acid exposure remains a reliable marker of the outcome. However, recurrences remain unexplained by LES pressure measurement and long-term follow-up using manometry and pH recording does not bring additional valuable data.
Topart
P
P
Service de Chirurgie Viscérale et Endocrinienne, Centre Hospitalier Universitaire, Brest, France. philippe.topart@univ-brest.fr
Vandenbroucke
F
F
Robaszkiewicz
M
M
Lozac'h
P
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D004943:Esophagogastric Junction / Q000503:physiopathology*; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011184:Postoperative Period; D011379:Prognosis