title: Esophageal motility after laparoscopic Roux-en-Y gastric bypass: the manometry should be preoperative examination routine?
abstract: BACKGROUND
  Our goal was to identify the changes of esophageal motility, lower esophageal sphincter (LES) function, and eating adaptation before and after Roux-en-Y gastric bypass (RYGBP) and whether manometry should be a routine examination in patients who undergo this procedure.
  
  
  METHODS
  A total of 81 patients underwent manometry before surgery and 1 year after surgery. The control group consisted of 10 nonobese volunteers. Patients were classified as presenting with vomiting and without vomiting 1 year after surgery. Manometric variables were compared before and after surgery. Statistical analysis was performed using Wilcoxon and Mann-Whitney test.
  
  
  RESULTS
  The patients (45.6%) had preoperative manometric findings, 29.8% had LES hypertonia, 18.9% LES hypotonia, 43.2% increase in wave amplitude of contraction, and three 8.1% abnormal peristalsis. One year after surgery manometry was abnormal in 62.9% of patients, 11.7% with hypertonia and 15.7% with hypotonia of the LES, 53% with changes in amplitude contraction and 19.6% with abnormal peristalsis. The control group showed no manometric abnormalities. Chronic vomiting was noted in 21% of patients. When comparing all variables between the pre and postoperative periods, there was no significant difference for all of them except for peristalsis. Comparing the results of manometric findings between the vomiting and non-vomiting groups, no significant changes were found in the variables studied.
  
  
  CONCLUSIONS
  There was an association between RYGBP and motor abnormalities in the esophagus but no differences in postoperative feeding adaptation. Thus, we conclude that esophageal manometry is not necessary as a routine preoperative examination.
authors.affiliation: Department of Surgery, Londrina State University, Rua Santos 777 apto 1302, 86020-041 Londrina, Paraná, Brazil. valezi@sercomtel.com.br
authors.forename: Antonio Carlos
authors.initials: AC
authors.lastname: Valezi
authors.forename: Fernando Augusto Mardiros
authors.initials: FA
authors.lastname: Herbella
authors.forename: Jorge Mali
authors.initials: JM
authors.lastname: Junior
authors.forename: Mariano
authors.initials: M
authors.lastname: de Almeida Menezes
mesh_terms: D000328:Adult; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D010528:Peristalsis; D011300:Preoperative Care; D016896:Treatment Outcome; D014839:Vomiting / Q000209:etiology; D055815:Young Adult