title: Total fundoplication does not obstruct the esophageal secondary peristalsis: investigation with pre- and postoperative 24-hour pH-multichannel intraluminal impedance.
abstract: 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.
authors.affiliation: First Division of General and Gastrointestinal Surgery, Second University of Naples, Naples, Italy. gdg@doctor.com
authors.forename: G
authors.initials: G
authors.lastname: del Genio
authors.forename: S
authors.initials: S
authors.lastname: Tolone
authors.forename: G
authors.initials: G
authors.lastname: Rossetti
authors.forename: L
authors.initials: L
authors.lastname: Brusciano
authors.forename: F
authors.initials: F
authors.lastname: del Genio
authors.forename: F
authors.initials: F
authors.lastname: Pizza
authors.forename: F
authors.initials: F
authors.lastname: Russo
authors.forename: M
authors.initials: M
authors.lastname: Di Martino
authors.forename: V
authors.initials: V
authors.lastname: Napolitano
authors.forename: A
authors.initials: A
authors.lastname: del Genio
mesh_terms: 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