Postoperative esophageal physiology studies may help to predict long-term symptoms following laparoscopic Nissen fundoplication.
BACKGROUND
Laparoscopic Nissen fundoplication is an established treatment for gastroesophageal reflux disease (GERD). Postoperative improvement in esophageal physiology can be indicative of successful surgery, but the degree to which it correlates with symptom control remains questionable. We have performed this study to assess the utility of postoperative esophageal physiology studies in predicting long-term symptomatic outcome.


METHODS
Between August 1997 and August 2003, 145 patients with symptomatic GERD underwent laparoscopic Nissen fundoplication as part of a randomized trial. Four months after surgery patients were invited to have postoperative esophageal physiology studies. In November 2005, a postal questionnaire was sent to all patients in order to assess reflux symptomatology (DeMeester symptom score).


RESULTS
Completed symptom questionnaires were returned by 108 patients (74%) after a median of 5.7 years postoperatively. Linear regression of manometry data showed a significant correlation between the level of postoperative neosphincter pressure either above or below the median and long-term scores for heartburn (p = 0.03), dysphagia (p = 0.02), regurgitation (p = 0.01), and total symptom score (p = 0.002). In contrast, there was no evidence of a significant correlation between results of postoperative esophageal pH studies and symptom scores.


CONCLUSIONS
Postoperative physiology studies, particularly manometry, may be predictive of long-term symptoms following laparoscopic Nissen fundoplication.
Boddy
A P
AP
Department of General Surgery, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK.
Mehta
S
S
Bennett
J
J
Lowndes
R
R
Mahon
D
D
Rhodes
M
M
D000328:Adult; D000368:Aged; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology; D050782:Esophageal pH Monitoring; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008365:Manometry; D008875:Middle Aged; D011184:Postoperative Period; D011237:Predictive Value of Tests; D012008:Recurrence; D011795:Surveys and Questionnaires; D016896:Treatment Outcome