Can intraoperative manometry during laparoscopic fundoplication predict postoperative dysphagia?
BACKGROUND
Many trials have used intraesophageal manometry (IEM) to measure the adequacy of fundoplication. This pilot study aimed to assess the value of IEM in predicting postoperative dysphagia.


METHODS
A series of 40 patients underwent IEM studies before operative correction of gastroesophageal reflux disease and repeat studies 3 months after the procedure. During the operation, IEM studies were undertaken before pneumoperitoneum was established, after pneumoperitoneum, after pneumoperitoneum with fundoplication, and after fundoplication without pneumoperitoneum. All the patients were followed up 1, 6, and 12 months after the procedure for assessment to detect persistent reflux and postfundoplication dysphagia.


RESULTS
Three patients demonstrated persistent dysphagia at the 12-month follow-up point. No statistically significant differences in preoperative manometry findings were observed in the dysphagic and nondysphagic groups, with the dysphagic group showing higher pressures. However, at the operation, statistically significant differences in the lower esophageal sphincter pressures were observed after anesthesia and no pneumoperitoneum (30.3 vs. 13.4 cm H(2)O; p =0.002), after anesthesia with pneumoperitoneum (40.3 vs. 18.3 cm H(2)O; p < 0.001), and after fundoplication with pneumoperitoneum (47.3 vs. 23.4 cm H(2)O; p = 0.001). No statistically significant differences were demonstrated in postoperative manometry at the 3-month follow-up point.


CONCLUSIONS
Intraoperative manometry may be a useful tool compared with postoperative manometry in identifying patients who may experience postfundoplication dysphagia.
Khan
M
M
Department of Surgery, Royal Hallamshire Hospital, Sheffield, UK. manskhan@doctors.org.uk
Smythe
A
A
Elghellal
K
K
Ackroyd
R
R
D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D003680:Deglutition Disorders / Q000175:diagnosis*; D050782:Esophageal pH Monitoring; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D010865:Pilot Projects; D011028:Pneumoperitoneum, Artificial; D011183:Postoperative Complications / Q000175:diagnosis*; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D016896:Treatment Outcome