Laparoscopic antireflux surgery: preoperative lower esophageal sphincter pressure does not affect outcome.
BACKGROUND
Concern has been raised about operating on patients with gastroesophageal reflux disease (GERD) and normal lower esophageal sphincter (LES) pressure for the fear that a fundoplication may fail to control reflux and result in a high rate of postoperative dysphagia. We hypothesized that fundoplication is effective in patients with GERD irrespective of the preoperative LES pressure, and that in patients with normal LES pressure, a total fundoplication does not result in a high incidence of dysphagia.


METHODS
We studied 280 unselected patients with GERD who underwent laparoscopic fundoplication. They were divided in three groups based on the preoperative LES pressure (normal, 14-24 mmHg): group A (LES pressure, 0-6 mmHg; 61 patients; 22%); group B (LES pressure, 7-13 mmHg; 178 patients; 64%); group C (LES pressure, >or=14 mmHg; 41 patients; 14%). De novo dysphagia was defined as new onset of postoperative dysphagia lasting more than 10 weeks. The average follow-up period was 17 +/- 22 months.


RESULTS
There was no difference in resolution of symptoms among the three groups. Heartburn and regurgitation resolved or improved respectively in 96% of group A, 90% of group B, and 91% of group C patients. In addition, there was no difference in the incidence of de novo dysphagia, which occurred in 8% of group A, 7% of group B, and 2% of group C.


CONCLUSIONS
We conclude that fundoplication controlled GERD irrespective of preoperative LES pressure, and that a normal LES pressure before surgery was not associated with a higher rate of postoperative dysphagia.
Patti
M G
MG
Department of Surgery and Swallowing Center, University of California, 533 Parnassus Avenue, Room U-122, San Francisco, CA 94143-0788, USA. pattim@surgery.ucsf.edu
Perretta
S
S
Fisichella
P M
PM
D'Avanzo
A
A
Galvani
C
C
Gorodner
V
V
Way
L W
LW
D000704:Analysis of Variance; D003680:Deglutition Disorders / Q000209:etiology; D004943:Esophagogastric Junction / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000009:adverse effects / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000503:physiopathology* / Q000601:surgery*; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008365:Manometry; D008875:Middle Aged
D006635:Histamine H2 Antagonists