Total fundoplication does not obstruct the esophageal secondary peristalsis: investigation with pre- and postoperative 24-hour pH-multichannel intraluminal impedance.
OBJECTIVE
To determine the impact of total fundoplication on the spontaneous esophageal clearance, known as secondary peristalsis.


BACKGROUND
Although there is general agreement that total fundoplication is not an obstacle to bolus swallowing (primary peristalsis), whether it is an obstacle to spontaneous esophageal clearance (secondary peristalsis) is still not clear. Based on 24-hour monitoring, multichannel intraluminal impedance was used to calculate the time of spontaneous bolus clearance (BCT).


METHODS
Mean BCT was prospectively calculated in 15 consecutive patients before and after total fundoplication. BCT was calculated in seconds including all the gastroesophageal reflux episodes, whereas bolus swallows (solid meals and liquid swallows) were excluded from the analysis.


RESULTS
BCT was extrapolated from 1,057 episodes in the 623 h of study. Overall, BCT did not change after surgery (13.6 +/- 4 vs. 15.2 +/- 10 s; p = nonsignificant) and in the upright (12.2 +/- 3 vs. 16.5 +/- 7 s; p = nonsignificant) and recumbent position (22.9 +/- 9 vs. 23.0 +/- 9 s; p = nonsignificant).


CONCLUSIONS
In this study total fundoplication did not affect the BCT by combined 24-hour ph monitoring and multichannel intraluminal impedance.
del Genio
G
G
First Division of General and Gastrointestinal Surgery, Second University of Naples, Naples, Italy. gdg@doctor.com
Tolone
S
S
Rossetti
G
G
Brusciano
L
L
del Genio
F
F
Pizza
F
F
Russo
F
F
Di Martino
M
M
Napolitano
V
V
del Genio
A
A
D000328:Adult; D003679:Deglutition; D050782:Esophageal pH Monitoring; D004947:Esophagus / Q000503:physiopathology*; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D010528:Peristalsis; D011184:Postoperative Period; D011300:Preoperative Care; D011446:Prospective Studies; D016896:Treatment Outcome