PROGNOSTIC VALUE OF ESOPHAGEAL MANOMETRY IN ANTIREFLUX SURGERY IN CHILDHOOD

To assess the predictive value of preoperative esophageal manometric s tudy in the outcome of antireflux surgery, 14 children with severe gas troesophageal reflux (GER) who underwent surgery were studied retrospe ctively. Five patients had neuromuscular disease; one had been operate d on for esophageal atresia. After extended (>20 h) esophageal pH moni toring and/or barium swallow study, all patients underwent preoperativ e manometric study. After surgery, the patients were followed for 4 mo nths to 4 years. Functional complications were noted after mechanical complications were eliminated. All patients had normal upper esophagea l sphincter pressure (UESp); the resting lower esophageal sphincter pr essure (LESp) was decreased in four patients, and seven had esophageal body motility trouble. Functional complications occurred in two patie nts. One was a neurologically involved patient who had had a normal pr eoperative manometric study; the other was the patient who had been op erated on for esophageal atresia. No complications occurred in four pa tients who had had abnormal preoperative manometric studies. We conclu de that, in this group of patients, esophageal manometric study has no predictive value in the outcome of the surgical procedure; however, i t still would be interesting to elucidate the mechanisms of GER, espec ially in congenital abnormalities such as esophageal atresia.