OUTCOME OF LAPAROSCOPIC NISSEN FUNDOPLICATION IN PATIENTS WITH DISORDERED PREOPERATIVE PERISTALSIS

Background-A 360 degrees or Nissen fundoplication remains controversia l in patients with disordered peristalsis, some surgeons preferring a partial wrap to minimise postoperative dysphagia. Aim-To evaluate symp toms manometric outcome in patients disordered peristalsis after Nisse n fundoplication. Patients-In an initial series of 345 patients studie d prospectively, 31 patients who had undergone a Nissen fundoplication had disordered peristalsis. Using preoperative manometry, patients we re classified as: equivocal primary peristalsis (eight patients); abno rmal primary peristalsis (four patients); abnormal maximal contraction pressure (13 patients); abnormal primary peristalsis and maximal cont raction pressure (six patients). Methods-Postoperatively, patients und erwent a barium meal, oesophageal manometry and standardised clinical review by a blinded scientific officer. Results-Twenty eight (90%) pat ients had satisfaction scores of at least 8 out of a maximum of 10 and all would undergo surgery again. Whereas 15 (48%) patients had dyspha gia scores greater than 4/10 preoperatively, only two (6%) had these s cores at one year. Improved peristalsis was seen in 78% of postoperati ve manometric studies, and mean preoperative lower oesophageal sphinct er pressure increased from 6 . 6 (range 0-21) mm Hg to 19 (4-50) mm Hg . Conclusions-These results are similar to the overall group of 345 pa tients and suggest that disordered peristalsis, and possibly even abse nt peristalsis, is not a contraindication to Nissen fundoplication as performed in these patients.