EVALUATION OF THE ANTIREFLUX MECHANISM FOLLOWING LAPAROSCOPIC FUNDOPLICATION

Background Laparoscopic Nissen fundoplication is an effective procedur e for the treatment of gastrooesophageal reflux disease (GORD), but th e underlying motility mechanisms that explain the success of this oper ation remain unclear. Methods Twenty patients with a history of GORD u nderwent stationary oesophageal manometry and prolonged ambulatory pH monitoring, both before and 3 months after fundoplication. Results Eig hteen patients were completely cured of reflux symptoms and stopped al l antireflux medication after operation. After fundoplication there wa s a significant increase (P < 0.01) in median resting lower oesophagea l sphincter (LOS) pressure and length. Median residual LOS pressure du ring swallow-induced LOS relaxation also increased significantly after operation (P < 0.01). The number of reflux episodes decreased from a median of 48 to 3 after fundoplication (P < 0.01). The time at pH less than 4 decreased from 5.7 to 0 per cent in the supine position (P < 0 .01), and from 9.8 to 0.2 per cent while upright (P < 0.001). Conclusi on Early subjective results at 3 months following laparoscopic antiref lux surgery show improved symptoms. One of the mechanisms underlying t he antireflux action of fundoplication is an increase in median residu al LOS pressure at the gastro-oesophageal junction. This may be a pure ly mechanical effect of the fundic wrap extrinsic to the LOS.