CONCURRENT FLUOROSCOPY AND MANOMETRY REVEAL DIFFERENCES IN LAPAROSCOPIC NISSEN AND ANTERIOR FUNDOPLICATION

A prospective double-blind randomized trial was initiated to examine t wo types of laparoscopic fundoplication (Nissen and anterior). Thirty- two patients with proven gastroesophageal reflux disease presenting fo r primary laparoscopic antireflux surgery were randomized to undergo e ither Nissen fundoplication (N = 13) or anterior hemifundoplication (N = 19), Postoperative fluoroscopic and manometric examination was carr ied out concomitantly. Nissen fundoplication resulted in significantly greater elevation of resting (33.5 vs 23 mm Hg) and residual lower es ophageal sphincter pressures (17 vs 6.5 mm Hg) and lower esophageal ra mp pressure (26 vs 20.5 mm Hg) than the anterior partial fundoplicatio n. A smaller radiologically measured sphincter opening diameter was se en following Nissen fundoplication (9 mm) compared with anterior fundo plication (13, mm). Lower esophageal ramp pressure correlated weakly ( r = 0.37, P = 0.04) with postoperative dysphagia. It is concluded that the type of fundoplication performed significantly influences postope rative manometric and video barium radiology outcomes. The clinical re levance of this requires further investigation.