Outcomes of laparoscopic Nissen fundoplication in patients with the "hypercontractile esophagus".
OBJECTIVE
To determine if a hypercontractile esophagus, manifested by high-amplitude peristaltic contractions (HAPCs) or hypertensive lower esophageal sphincter (HLES), affects the outcome of antireflux surgery.


METHODS
Case series. Prospectively maintained database. Direct contact with patients. Mean follow-up 28.7 months.


METHODS
University hospital.


METHODS
Of 643 patients who had antireflux surgery for uncomplicated gastroesophageal reflux disease (GERD), 15 had HAPCs (> or = 150 mm Hg) and 4 HLES (> or = 45 mm Hg).


METHODS
Laparoscopic Nissen fundoplication in all patients.


METHODS
(1) Frequency of hypercontractile esophagus in patients considered for antireflux procedure. (2) Effect of fundoplication on esophageal acid exposure and symptoms. (3) Establish whether dysphagia or chest pain develop after fundoplication.


RESULTS
The typical GERD symptoms of heartburn and/or regurgitation occurred in 15 (79%) and 13 (69%) of 19 patients. Dysphagia was present in 5 of 15 patients with HAPCs and in 0 of 4 with HLES; chest pain was found 5 of 15 patients with HAPCs. After fundoplication acid exposure was improved in all (92%, 16/17) but 1 and was totally normal in 10 patients (83%). Heartburn improved in 11(78%) of 14 and resolved in 8 patients (57%) of the 14. Chest pain improved in 4 (80%) of the 5 patients who had it, and developed in 3 (23%) who did not have it preoperatively. In patients with HAPCs, dysphagia improved in 4 (80%) of 5 patients with complete resolution in 3 (60%). New dysphagia developed in 2 (11%) of the 19 patients, 1 in each group. No patient with HLES developed chest pain.


CONCLUSIONS
High-amplitude peristaltic contractions or HLES may be associated with GERD in a subset of patients with dysphagia or chest pain. In such patients, a Nissen fundoplication, by effectively controlling GERD, relieves these symptoms in most patients. A hypercontractile esophagus in patients with GERD should not be considered a contraindication to a total fundoplication. The surgeon and the patient should be aware of the risk of developing chest pain after the operation.
Barreca
Marco
M
Department of Surgery, University of Washington, Seattle, USA.
Oelschlager
Brant K
BK
Pellegrini
Carlos A
CA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002637:Chest Pain / Q000209:etiology; D003680:Deglutition Disorders / Q000209:etiology; D004947:Esophagus / Q000503:physiopathology*; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010528:Peristalsis; D016896:Treatment Outcome