The lower esophageal sphincter strength in patients with gastroesophageal reflux before and after laparoscopic Nissen fundoplication.
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.
Schneider
J H
JH
Department of Visceral Surgery and Transplantation of University of Tübingen, Tübingen, Germany. joachim.schneider@med.uni-tuebingen.de
Kramer
K M
KM
Königsrainer
A
A
Granderath
F A
FA
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