title: Outcomes of laparoscopic Nissen fundoplication in patients with manometric patterns of esophageal motility disorders.
abstract: The manometric pattern of either diffuse esophageal spasm (DES), nutcracker esophagus (NE), or hypertensive lower esophageal sphincter (HLES) in the presence of gastroesophageal reflux disease (GERD) is considered a secondary finding and treatment should be directed toward GERD. This study aims to evaluate the outcomes of laparoscopic Nissen fundoplication (LNF) in patients with manometric patterns of esophageal motility disorders. Patients with GERD confirmed by pH monitoring and manometric pattern of DES (simultaneous contractions 20 to 90% of wet swallows), NE (increased mean distal amplitude greater than 180 mmHg), or HLES (lower esophageal sphincter pressure greater than 45 mmHg) who underwent LNF were studied. A group of 50 consecutive patients with normal esophageal motility who underwent LNF were used as control subjects. Groups were comparable to control subjects for age, gender, preoperative symptoms, hiatal hernia, and Barrett's esophagus, except for NE that had younger individuals and a lower rate of hiatal hernia. Symptomatic outcome was similar when groups were compared with control subjects. Transient dysphagia was present in the postoperative period in 33, 7, 0, and 20 per cent of the patients with HLES, DES, NE, and control subjects, respectively. LNF is an adequate treatment for patients with GERD and manometric patterns of esophageal motility disorders.
authors.affiliation: Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Bruna
authors.initials: B
authors.lastname: Dell'Acqua-Cassão
authors.forename: Fernando Augusto
authors.initials: FA
authors.lastname: Mardiros-Herbella
authors.forename: José F
authors.initials: JF
authors.lastname: Farah
authors.forename: Adorisio
authors.initials: A
authors.lastname: Bonadiman
authors.forename: Luciana C
authors.initials: LC
authors.lastname: Silva
authors.forename: Marco G
authors.initials: MG
authors.lastname: Patti
mesh_terms: D015154:Esophageal Motility Disorders / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D018662:Fundoplication / Q000379:methods; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000601:surgery; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008365:Manometry; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome