Esophagography predicts favorable outcomes after laparoscopic Nissen fundoplication for patients with esophageal dysmotility.
BACKGROUND
We undertook this study to determine if clearance of a food bolus at preoperative esophagography predicts acceptable outcomes after laparoscopic Nissen fundoplication for patients with manometrically abnormal esophageal motility.


METHODS
Patients with gastroesophageal reflux disease (GERD) or symptomatic hiatal hernia with evidence of esophageal dysmotility by stationary manometry underwent videoesophagography to document the ability of their esophagus to clear food boluses of varying consistencies. Sixty-six patients were identified who had manometric dysmotility yet were able to clear a food bolus at esophagography, and subsequently underwent laparoscopic Nissen fundoplication. These patients were compared with 100 randomly selected patients with normal motility who underwent laparoscopic Nissen fundoplication. Symptom reduction and satisfaction were assessed through followup. Patients with normal motility were compared with those with manometrically moderate and severe dysmotility.


RESULTS
Preoperative patient demographic data, symptoms, and symptom scores were similar among patients with normal motility and moderate or severe dysmotility. After fundoplication, symptom reduction was notable for all patients regardless of preoperative motility (p < 0.01, paired Student's t-test). There was no notable difference in postoperative symptom scores (p = NS, Kruskal-Wallis ANOVA) or in patient satisfaction (p = NS, chi-square analysis) among patients stratified by esophageal motility.


CONCLUSIONS
Patients with esophageal dysmotility documented by manometry who are able to clear a food bolus at contrast esophagography, have functional results after laparoscopic Nissen fundoplication similar to patients with normal motility. Preoperative esophagography predicts successful outcomes after laparoscopic Nissen fundoplication for patients with manometric esophageal dysmotility.
D'Alessio
Matthew J
MJ
Department of Surgery, University of South Florida College of Medicine, Tampa, FL, USA.
Rakita
Steven
S
Bloomston
Mark
M
Chambers
Christopher M
CM
Zervos
Emmanuel E
EE
Goldin
Steven B
SB
Poklepovic
Jerry
J
Boyce
H Worth
HW
Rosemurgy
Alexander S
AS
D001466:Barium Sulfate; D003287:Contrast Media; D003679:Deglutition; D015154:Esophageal Motility Disorders / Q000503:physiopathology / Q000601:surgery*; D004947:Esophagus / Q000000981:diagnostic imaging* / Q000502:physiology; D005260:Female; D018662:Fundoplication / Q000379:methods; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011237:Predictive Value of Tests; D011859:Radiography; D016896:Treatment Outcome; D014741:Video Recording
D003287:Contrast Media; D001466:Barium Sulfate