Acid normalization and improved esophageal motility after Nissen fundoplication
Posted on 11/15/2011
Acid normalization and improved esophageal motility after Nissen fundoplication: equivalent outcomes in patients with normal and ineffective esophageal motility Abstract Background: Severe gastroesophageal reflux disease may result in acquired esophageal dysmotility.
The correct surgical approach to associated gastroesophageal reflux disease and dysmotility is controversial, in particular whether the “gold-standard” total fundoplication of Nissen is appropriate compared with partial fundoplication. Our unit has performed total fundoplication for all patients, irrespective of esophageal motility, and this article describes that experience.
Methods: Ninety-eight patients undergoing antireflux surgery were divided into 2 groups. Group 1 (n 60) consisted of patients with normal esophageal motility, and group 2 (n 38) had dysmotility. All patients underwent preoperative and postoperative manometry, 24-hour pH testing, symptom scoring, and quality-of-life assessment.
Results: The median postoperative acid score was not significantly different between groups 1 and 2. Eighty-eight percent of patients with normal motility and 89% of patients with dysmotility had no symptoms or minor symptoms, with a significant improvement in quality of life 6 months after surgery. There was a significant increase in esophageal wave amplitude in both groups, and 20 patients (53%) in the dysmotility group reverted to normal motility after surgery. Recurrent symptoms were associated with postoperative abnormal pH profiles in 5 patients from group 1 and 3 from group 2.
Conclusions: Preoperative dysmotility is not a contraindication for total fundoplication. Postoperative acid control is associated with improved esophageal clearance and symptoms.
Narayanasamy Ravi, F.R.C.S.I., Nael Al-Sarraf, M.B., Tracey Moran, M.A.G.I.P., James O’Riordan, A.F.R.C.S.I., Suzanne Rowley, B.Sc., Patrick J. Byrne, Ph.D., John V. Reynolds, F.R.C.S.I.*
University Department of Surgery, St James’ Hospital, Dublin 8, Ireland
Manuscript received December 9, 2004; revised manuscript May 2, 2005
The American Journal of Surgery 190 (2005) 445–450
