The researchers investigated esophageal motility in gastroesophageal reflux disease (GERD), before and after laparoscopic fundoplication.
They reported their findings in the July issue of Gastroenterology.
200 patients with a history of long-standing GERD were enrolled in the study. Clinical assessment, upper GI endoscopy, esophageal manometry, and 24-hour pH monitoring were conducted.
|Esophageal dysmotility does not affect postoperative clinical outcome.|
The patients were stratified according to presence (n = 100) or absence (n = 100) of esophageal dysmotility. They were then randomized to either Nissen or Toupet fundoplication.
4 months after the operation, preoperative tests were repeated.
Compared with normal motility, preoperative esophageal dysmotility was associated with more severe reflux symptoms. It was also associated with more frequent resistance to medical treatment (64% vs. 49%), and greater decrease in lower esophageal sphincter pressure (9.5 vs. 12.4 mm Hg).
Postoperatively, clinical outcome and reflux recurrences (21% vs. 14%) were similar.
Esophageal motility remained unchanged in 85% of patients. It changed from pathologic to normal in 20 patients (10 Nissen and 10 Toupet), and vice versa in 9 (8 Nissen and 1 Toupet).
Christiane Fibbe, of the Israelitic Hospital, Hamburg, said on behalf of the researchers, "Esophageal dysmotility reflects more severe GERD and is not corrected by fundoplication, independent of the surgical procedure performed. It may also occur as a result of fundoplication."
"Esophageal dysmotility does not affect postoperative clinical outcome and requires no tailoring of surgical management," it was concluded.