[The role of preoperative oesophageal manometry in patients with gastro-oesophageal reflux disease].
BACKGROUND
Oesophageal manometry has become a standard investigation in the management of functional disorders of the oesophagus. However, the importance of the various manometry parameters for the surgical management of patients with gastro-oesophageal reflux disease (GERD) has not yet been studied adequately.


OBJECTIVE
This study examined the importance of manometric findings on surgical treatment results in patients with GERD.


METHODS
Between January 1995 and January 2000, 123 consecutively referred patients with GERD symptoms were studied. Ninety-seven of these (52 women and 45 men, mean age 48 years) underwent Nissen fundoplication in conventional or laparoscopic technique. Preoperatively, each patient received stationary oesophageal manometry with a water perfusion catheter, gastroduodenoscopy and 24h-pH-metry of the oesophagus. Independent of manometric results, patients received 360 degrees fundoplicatio with 2 cm cuff ("floppy Nissen").


RESULTS
Eighty-five of the 97 patients (88 %) had an incompetent lower oesophageal sphincter. Hypomotility was diagnosed in 17 (18 %). Amotile achalasia and diffuse oesophageal spasms were seen in two and one patient, respectively, who were not operated on. Follow-up data were available for 92 % of patients (mean follow-up time 1.8 years). Five and 8 patients (1 and 2 of these with hypomotility) postoperatively developed persistent dysphagia and GERD recurrence, respectively (relative risks 1.2 and 1.6). Two patients (one with hypomotility) required surgical revision.


CONCLUSIONS
Preoperative oesophageal manometry in GERD patients is useful only for determining the position of the upper boundary of the lower oesophageal sphincter and for ruling out specific motility disorders. In patients with oesophageal hypomotility, "floppy Nissen" fundoplicatio can be performed without an excess risk of dysphagia.
Korenkov
M
M
Chirurgische Klinik, II. Lehrstuhl für Chirurgie, Universität zu Köln, Germany. michael.korenkov@uni-koeln.de
Sauerland
S
S
Yücel
N
N
Neugebauer
E A M
EA
Troidl
H
H
D003680:Deglutition Disorders / Q000209:etiology / Q000503:physiopathology; D015154:Esophageal Motility Disorders / Q000503:physiopathology / Q000601:surgery; D004943:Esophagogastric Junction / Q000503:physiopathology / Q000601:surgery; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D011300:Preoperative Care; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome