ESOPHAGEAL MOTILITY IN GASTROESOPHAGEAL REFLUX DISEASE BEFORE AND AFTER LAPAROSCOPIC NISSEN FUNDOPLICATION

Hamdy, Emad; El-Hemaly, Mohamed; Salah, Tarek; El-Nakeeb, Ayman; Askar, Waleed; Ezzat, Helmy; Haleem, Magdy; El-Hak, Nabil Gad

doi:10.21608/ejsur.2013.366731

ESOPHAGEAL MOTILITY IN GASTROESOPHAGEAL REFLUX DISEASE BEFORE AND AFTER LAPAROSCOPIC NISSEN FUNDOPLICATION

Document Type : Original Article

Authors

Gastroenterology Center, Mansoura University, Egypt

10.21608/ejsur.2013.366731

Abstract

Background and Aims: The aim of this study was to determine whether esophageal motor function changes
after Laparoscopic Nissen Fundoplication (LNF) and whether esophageal dysmotility affects symptoms of
Gastro-Esophageal Reflux Disease (GERD) or clinical outcome postoperatively.
Methods: This study included 200 patients with GERD who were operated upon by LNF in El-Mansoura
Gastroenterology Surgical Center in the period between January, 2002 and March, 2008. All patients were
subjected preoperatively to thorough clinical evaluation, upper endoscopy, barium study, esophageal
manometry and 24-hour pH metry. Patients were stratified according to presence (24 cases) or absence of
esophageal dysmotility (176 cases) and all underwent LNF. At postoperative follow-up (early within 6
months and late after 5 years from the date of surgery), preoperative tests were repeated,
Results: Mean Lower Esophageal Sphincter (LES) pressure improved from 10.9 mmHg to 22.3 mmHg
(p<.001), while, the amplitude of peristaltic waves in different parts of the esophagus showed no significant
change and the results were nearly similar to the preoperative values (p>.05). Esophageal dysmotility had no
effect on the severity of reflux or the clinical outcome postoperatively (p>.05). All cases with preoperative
esophageal dysmotility had postoperative normal body motility (p<.001).
Conclusions: The significant increase in basal LES pressure after LNF in patients with symptomatic GERD
appears the most dramatic effect of fundoplication on esophageal physiology and should explain the efficacy
of the surgical antireflux procedure. Esophageal dysmotility (1) does not reflect more severe disease; (2) does
not affect postoperative clinical outcome; and (3) may improve with fundoplication.

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