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Value of preoperative esophageal function studies before laparoscopic antireflux surgery.
- Source :
-
Surgical endoscopy [Surg Endosc] 2011 Sep; Vol. 25 (9), pp. 2943-9. Date of Electronic Publication: 2011 Mar 18. - Publication Year :
- 2011
-
Abstract
- Background: The value of esophageal manometry and ambulatory pH monitoring before laparoscopic antireflux surgery (LARS) has been questioned because tailoring the operation to the degree of hypomotility often is not required. This study evaluated a consecutive cohort of patients referred for esophageal function studies in preparation for LARS to determine the rates of findings that would alter surgical decisions.<br />Methods: High-resolution manometry (HRM) was performed for each subject using a 21-lumen water-perfused system, and motor function was characterized. Gastroesophageal reflux disease (GERD) was evident from ambulatory pH monitoring if thresholds for acid exposure time and/or positive symptom association probability were passed.<br />Results: Of 1,081 subjects (age, 48.4 ± 0.4 years; 56.7% female) undergoing preoperative HRM, 723 (66.9%) also had ambulatory pH testing performed. Lower esophageal sphincter (LES) hypotension (38.9%) and nonspecific spastic disorder (NSSD) of the esophageal body (36.1%) were common. Obstructive LES pathophysiology was noted in 2.5% (achalasia in 1%; incomplete LES relaxation in 1.5%), and significant esophageal body hypomotility in 4.5% (aperistalsis in 3.2%; severe hypomotility in 1.3%) of the subjects. Evidence of GERD was absent in 23.9% of the subjects. Spastic disorders were more frequent in the absence of GERD (43.9% vs. 23.1% with GERD; p < 0.0001), whereas hypomotility and normal patterns were more common with GERD.<br />Conclusions: Findings considered absolute or relative contraindications for standard 360º fundoplication are detected in 1 of 14 patients receiving preoperative HRM. Additionally, spastic findings associated with persistent postoperative symptoms are detected at esophageal function testing that could be used in preoperative counseling and candidate selection. Physiologic testing remains important in the preoperative evaluation of patients being considered for LARS.
- Subjects :
- Cohort Studies
Contraindications
Esophageal Motility Disorders complications
Esophageal Motility Disorders physiopathology
Female
Gastroesophageal Reflux complications
Humans
Male
Middle Aged
Retrospective Studies
Esophageal Motility Disorders diagnosis
Esophageal pH Monitoring
Esophagus physiopathology
Fundoplication
Gastroesophageal Reflux surgery
Laparoscopy
Manometry
Monitoring, Ambulatory
Preoperative Care methods
Subjects
Details
- Language :
- English
- ISSN :
- 1432-2218
- Volume :
- 25
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- Surgical endoscopy
- Publication Type :
- Academic Journal
- Accession number :
- 21424193
- Full Text :
- https://doi.org/10.1007/s00464-011-1646-9