Does laparoscopic antireflux surgery prevent the occurrence of transient lower esophageal sphincter relaxation?
BACKGROUND
Transient lower esophageal sphincter relaxation (TLESR) is the most common mechanism underlying gastroesophageal reflux disease (GERD), causing 70% to 100% of the reflux episodes in normal subjects and 63% to 74% of the reflux episodes in patients with reflux disease. This study aimed to evaluate the effect of laparoscopic Nissen fundoplication on TLESR in patients with proven GERD.


METHODS
We prospectively followed 73 consecutive patients (13 men and 60 women; mean age, 43.7 +/- 1.72 years) with proven diagnosis of GERD and reported TLESRs found during a 40-min esophageal manometric study. These patients had repeat testing 6 months after undergoing laparoscopic Nissen fundoplication.


RESULTS
Laparoscopic Nissen fundoplication increased the basal and nadir lower esophageal sphincter (LES) pressure and significantly reduced the number of TLESRs during the manometric study. No patients after surgery exhibited TLESR with nadir less than 2 mmHg. However, 8 of the 73 patients (11%) exhibited TLESR to a nadir exceeding 50% of basal pressure (mean nadir, 5.0 +/- 1.07 mmHg).


CONCLUSIONS
The number of TLESRs is reduced significantly by antireflux surgery. Even accounting for increased basal and nadir pressures, the incidence of TLESR is reduced, suggesting that there may be additional mechanisms involved in this process.
Department of Surgery, St. Joseph's Healthcare, McMaster University, 50 Charlton Avenue East, Hamilton, Ontario, Canada L8N 4A6.
F
F
Bahmeriz
S
S
Dutta
C J
CJ
Allen
C Gill
CG
Pottruff
M
M
Anvari
D000328:Adult; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology*; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D009126:Muscle Relaxation; D011312:Pressure; D011446:Prospective Studies