Total fundoplication controls acid and nonacid reflux: evaluation by pre- and postoperative 24-h pH-multichannel intraluminal impedance.
BACKGROUND
Studies have demonstrated that Nissen fundoplication controls acid gastroesophageal reflux (GER). Combined 24-h pH and multichannel intraluminal impedance (MII-pH) allows detection of both acid and nonacid GER. Antireflux surgery is considered for any patient whose medical therapy is not efficient, particularly patients with nonacid gastroesophageal reflux disease (GERD). Nevertheless, fundoplication used to control nonacid reflux has not been reported to date.


METHODS
In this study, 15 consecutive patients who underwent laparoscopic Nissen-Rossetti fundoplication had MII-pH both before and after the surgical procedure. The numbers of acid and nonacid GER episodes were calculated with the patient in both upright and recumbent positions.


RESULTS
The 24-h pH monitoring confirmed the postoperative reduction of exposure to acid (p < 0.05). Postoperatively, the total, acid, and nonacid numbers of GER episodes were reduced (p < 0.05).


CONCLUSIONS
According to the findings, MII-pH is feasible and well tolerated. It provides an objective means for evaluating the effectiveness of Nissen-Rossetti fundoplication in controlling both acid and nonacid GER.
del Genio
Gianmattia
G
First Division of General and Gastrointestinal Surgery, Second University of Naples, via Pansini, 5, 80131, Naples, Italy. gdg@doctor.com
Tolone
Salvatore
S
del Genio
Federica
F
Rossetti
Gianluca
G
Brusciano
Luigi
L
Pizza
Francesco
F
Fei
Landino
L
del Genio
Alberto
A
D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D017097:Electric Impedance; D050782:Esophageal pH Monitoring; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011187:Posture / Q000502:physiology; D016896:Treatment Outcome