title: Laparoscopic antireflux surgery: preoperative lower esophageal sphincter pressure does not affect outcome.
abstract: 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.
authors.affiliation: 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
authors.forename: M G
authors.initials: MG
authors.lastname: Patti
authors.forename: S
authors.initials: S
authors.lastname: Perretta
authors.forename: P M
authors.initials: PM
authors.lastname: Fisichella
authors.forename: A
authors.initials: A
authors.lastname: D'Avanzo
authors.forename: C
authors.initials: C
authors.lastname: Galvani
authors.forename: V
authors.initials: V
authors.lastname: Gorodner
authors.forename: L W
authors.initials: LW
authors.lastname: Way
mesh_terms: 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
chemical_list: D006635:Histamine H2 Antagonists