M. Gadenstatter et al., Laparoscopic partial posterior fundoplication provides excellent intermediate results in GERD patients With impaired esophageal peristalsis, SURGERY, 126(3), 1999, pp. 548-552
Background. Gastroesophageal reflux disease (GERD) is frequently associated
with impaired esophageal peristalsis, and many authorities consider this c
ondition not suitable for Nissen fundoplication.
Methods. To investigate the outcome of antireflux surgery in the presence o
f impaired esophageal peristalsis, 78 consecutive GERD patients with poor e
sophageal contractility who underwent laparoscopic partial posterior fundop
lication were studied. A standardized questionnaire, upper gastrointestinal
endoscopy, esophageal manometry, and 24-hour pH monitoring were performed
preoperatively and at a median of 31 months (range 6-57 months) postoperati
vely. Esophageal motility was analyzed for contraction amplitudes in the di
stal true thirds of the esophagus, frequency of peristaltic, simultaneous,
and interrupted waves, and the total number of defective propagations. In a
ddition, parameters defining the function of the lower esophageal sphincter
were evaluated.
Results. After antireflux surgery, 76 patients (97%) were free of heartburn
and regurgitation and had no esophagitis on endoscopy. The rate of dysphag
ia decrease from 49% preoperatively to 10% postoperatively (P <.001). Featu
res defining impaired esophageal body motility improved significantly after
antireflux surgery. The median DeMeester score on 24-hour esophageal pH mo
nitoring decreased from 33.3 to 1.1 (P <.001).
Conclusions. Partial posterior fundoplication provides an effective antiref
lux barrier in patients with impaired esophageal body motility. Postoperati
ve dysphagia is diminished, probably because of improved esophageal body fu
nction.