title: Effect of laparoscopic antireflux surgery on esophageal motility.
abstract: OBJECTIVE
  The effect of laparoscopic antireflux surgery on esophageal motility is incompletely understood, and any indication for this procedure in patients with motility disorder is disputed in literature. We evaluated the influence of laparoscopic Nissen fundoplication on impaired esophageal motility.
  
  
  METHODS
  In this pathological manometric study, we divided the patients into two groups preoperatively: the hypomotility group (mean amplitude of esophageal contraction wave <40 mm Hg; HYPO group, n = 11) and the normal group (mean amplitude of esophageal contraction wave >40 mm Hg; NORM group, n = 43). The amplitudes of esophageal contraction waves 3 and 8 cm above the lower esophageal sphincter and the percentage of peristaltic contraction waves of the tubular esophagus were analyzed pre- and postoperatively.
  
  
  RESULTS
  In total, 54 patients with GERD underwent esophageal manometry before and 6 months after Nissen fundoplication. The length and pressure of the lower esophageal sphincter were increased in both groups postoperatively (p < 0.01). Patients in the HYPO group (n = 11) showed a statistically significant increase of mean amplitude of esophageal contraction (32.8 vs. 57.3 mm Hg; p < 0.01), while no change was found in the NORM group (n = 43). A total of 72% of patients with preoperative motility disorder showed normal postoperative manometry.
  
  
  CONCLUSIONS
  Nissen fundoplication normalizes esophageal motility, especially in patients with preoperative hypomotility. Patients with impaired esophageal motility should not per se be excluded from antireflux surgery.
authors.affiliation: Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany.
authors.forename: Hans F
authors.initials: HF
authors.lastname: Fuchs
authors.forename: Christian A
authors.initials: CA
authors.lastname: Gutschow
authors.forename: Sebastian
authors.initials: S
authors.lastname: Brinkmann
authors.forename: Till
authors.initials: T
authors.lastname: Herbold
authors.forename: Marc
authors.initials: M
authors.lastname: Bludau
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schröder
authors.forename: Elfriede
authors.initials: E
authors.lastname: Bollschweiler
authors.forename: Arnulf H
authors.initials: AH
authors.lastname: Hölscher
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Leers
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D015154:Esophageal Motility Disorders / Q000175:diagnosis / Q000601:surgery*; D050782:Esophageal pH Monitoring; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008365:Manometry / Q000379:methods; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D055815:Young Adult