Nissen fundoplication: Intraoperative manometry or mechanical calibration?

Intraoperative manometry was performed in 7 consecutive patients undergoing Nissen fundoplication for gastroesophageal reflux disease. The aim of the study was to assess the effectiveness of the technique of mechanical calibration of the fundoplication with a 60-french Maloney bougie. Results showed a statistically significant increase of lower esophageal sphincter pressure and length over preoperative values. The values remained stable at 1 week and 6 months after operation. No patient had postoperative dysphagia or abnormal esophageal acid exposure on 24-hour esophageal pH monitoring. We conclude that mechanical calibration of the Nissen fundoplication is very effective in constructing an adequate antirefiux barrier. Intraoperative manometry adds time to the operation, and the information gained is of little practical value.