title: Backflow prevention mechanism of laparoscopic Toupet fundoplication using high-resolution manometry.
abstract: The use of multichannel intraluminal impedance pH (MII-pH) and high-resolution manometry (HRM), which are new devices used to examine the esophageal function, has recently become common in Europe and the USA, thus garnering much attention. There have not been enough studies as of yet, however, on the esophageal motor function and the benefits of treatment after these devices have been used in laparoscopic fundoplication.
  
  
  
  To use MII-pH and HRM to study the treatment effectiveness of laparoscopic fundoplication and consider a backflow prevention mechanism for laparoscopic Toupet fundoplication.
  
  
  
  The study looked at 27 of a total of 60 patients undergoing laparoscopic fundoplication due to reasons of either gastroesophageal reflux disease or esophageal hiatal hernia between October 2012 and February 2014, who underwent a postsurgical HRM examination. Of these, 25 patients whose symptoms disappeared following surgery and who were not orally administered gastric secretion inhibitor (of whom nine were male, average age 55.9 ± 14.9 years, and of whom 76 % underwent MII-pH) were taken as the subjects of the study. The postsurgical evaluation was conducted 3 months after the operation.
  
  
  
  Using HRM, although no change was noted in the lower esophageal sphincter pressure (LESP) (p = 0.943), an increase in lower esophageal sphincter pressure integral (p = 0.024) and extensions in both overall length and abdominal length were noted (both p < 0.001), while a significant improvement was noted in the lower esophageal sphincter (LES). Furthermore, the cases subjected to MII-pH demonstrated a reduced gastroesophageal reflux time, total number of liquid reflux episodes, and total number of reflux episodes (p < 0.001, p = 0.008, p = 0.009).
  
  
  
  Backflow prevention mechanism of laparoscopic Toupet fundoplication is thus considered to improve the overall LES function without elevating LESP.
authors.affiliation: Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan. qq2w2yb9@mist.ocn.ne.jp.
authors.forename: Masato
authors.initials: M
authors.lastname: Hoshino
authors.affiliation: Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Nobuo
authors.initials: N
authors.lastname: Omura
authors.affiliation: Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Yano
authors.affiliation: Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Kazuto
authors.initials: K
authors.lastname: Tsuboi
authors.affiliation: Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Se Ryung
authors.initials: SR
authors.lastname: Yamamoto
authors.affiliation: Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Akimoto
authors.affiliation: Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Kashiwagi
authors.affiliation: Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Yanaga
mesh_terms: D017097:Electric Impedance; D004724:Endoscopy; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology; D050782:Esophageal pH Monitoring; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006551:Hernia, Hiatal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011312:Pressure
keywords: Gastroesophageal reflux disease; Hiatal hernia; High-resolution manometry; Multichannel intraluminal impedance pH; Normal values; Toupet fundoplication