ESOPHAGEAL MOTILITY BEFORE AND AFTER LAPAROSCOPIC NISSEN FUNDOPLICATION

Background Whilst oesophageal manometry outcomes following fundoplicat ion performed by open techniques have been described, detailed reports of changes in manometric parameters following large series of laparos copic Nissen fundoplication have yet to be described. Methods An analy sis of oesophageal manometry studies performed on patients undergoing laparoscopic Nissen fundoplication at the Royal Adelaide Hospital was performed to quantitate the effect of surgery and to determine whether manometric indicators of adverse surgical outcome could be identified . The original manometric recordings from a subset of 103 patients wer e reviewed. Only patients who had undergone preoperative and postopera tive examinations in this department, and assessment by an independent investigator using a standardized clinical questionnaire, were includ ed in the study. Results Mean resting lower oesophageal sphincter (LOS ) pressure increased from 8.5 to 21.5 mmHg (P < 0.0001) following surg ery, the mean residual pressure after sphincter relaxation (residual r elaxation pressure) increased from 1.2 to 10.8 mmHg (P<0.0001), and oe sophageal 'ramp' pressure increased from 10.5 to 20.5 mmHg (P < 0.0001 ). Before operation 88 patients (85 per cent) propagated seven or more of ten wet swallows (normal peristalsis) versus 83 (81 per cent) afte r operation. Of the 15 patients with abnormal peristalsis before surge ry, eight regained normal peristalsis after operation, whereas 13 of 8 8 patients with normal preoperative peristalsis subsequently had defec tive postoperative peristalsis. Raised postoperative residual relaxati on pressure (r = 0.20) but not LOS pressure correlated significantly w ith postoperative dysphagia for liquids. None of the measured manometr ic parameters correlated with adverse outcomes such as postoperative d ysphagia for solids, patient dissatisfaction or gas bloat. Conclusion Whilst this study documents significant changes in LOS pressure follow ing laparoscopic Nissen fundoplication, a clinically significant corre lation between manometric outcome and clinical outcome was not demonst rated.