title: The lower esophageal sphincter strength in patients with gastroesophageal reflux before and after laparoscopic Nissen fundoplication.
abstract: Lower esophageal sphincter pressure (LESP) and sphincter strength (LESS) were measured before and after short and floppy laparoscopic Nissen fundoplication (LNF) in 38 patients with severe gastro-esophageal reflux disease (GERD). These patients were compared with a control group of 23 healthy volunteers. GERD was assessed by stationary manometry, 24-h pH recordings and endoscopy. LESS was verified by motorized pull-back of an air-filled balloon catheter from the stomach into the esophagus. The catheter assembly was well tolerated by all study participants. LESP increased significantly after operation from 8 mmHg to 14 mmHg (75% of normal values; P < 0.0001), but compared to the control group, LESP (22 mmHg) decreased significantly (P < 0.002). In the control group and in patients with GERD, LESP and LESS showed excellent correlation (r = 0.97, r = 0.94, respectively). After LNF, LESS increased significantly from 0.6 to 1.6 N (P < 0.0001), about 166%. We conclude that the measurement of LESS is able to explain the discrepancy between satisfactory NF operation and the distinct increase of postoperative LESP. The evaluation of LESS is a helpful tool in assessing functional understanding of laparoscopic Nissen fundoplication with a short and floppy wrap.
authors.affiliation: Department of Visceral Surgery and Transplantation of University of Tübingen, Tübingen, Germany. joachim.schneider@med.uni-tuebingen.de
authors.forename: J H
authors.initials: JH
authors.lastname: Schneider
authors.forename: K M
authors.initials: KM
authors.lastname: Kramer
authors.forename: A
authors.initials: A
authors.lastname: Königsrainer
authors.forename: F A
authors.initials: FA
authors.lastname: Granderath
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002404:Catheterization; D049630:Esophageal Sphincter, Lower / Q000502:physiology*; D050782:Esophageal pH Monitoring; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008365:Manometry; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology*; D011184:Postoperative Period; D011300:Preoperative Care; D011446:Prospective Studies