LAPAROSCOPIC PARTIAL FUNDOPLICATION FOR GASTROESOPHAGEAL REFLUX DISEASE (GERD) WITH IMPAIRED ESOPHAGEAL MOTILITY

Aly Nowara, Hany; El Serafy, Magdy

doi:10.21608/ejsur.2001.375858

LAPAROSCOPIC PARTIAL FUNDOPLICATION FOR GASTROESOPHAGEAL REFLUX DISEASE (GERD) WITH IMPAIRED ESOPHAGEAL MOTILITY

Document Type : Original Article

Authors

Hany Aly Nowara ¹
Magdy El Serafy ²

¹ Assistant professor of Surgery, Cairo University

² Assistant professor of Tropical medicine, Cairo University.

10.21608/ejsur.2001.375858

Abstract

Background: Gastroesophageal reflux disease (GERD) is frequently associated with impaired esophageal peristalsis,
and many authorities consider this condition not suitable for Nissen fundoplication.
Methods: To investigate the outcome of antireflux surgery in the presence of impaired esophageal peristalsis, 33 GERD
patients with poor esophageal contractility underwent laparoscopic partial fundoplication. Upper gastrointestinal
endoscopy, esophageal manometry, and 24-hour pH monitoring were performed preoperatively.
Results: After antireflux surgery, 30 patients (93%) were free of heartburn, regurgitation and bloating and had no
esophagitis on endoscopy. Twenty-eight patients (86%) were completely free of symptoms. The rate of dysphagia decreased from 44% preoperatively to 9% postoperatively (P < .001). The median DeMeester score on 24-hour esophageal pH monitoring decreased from 34.5 to 1.15 (P < .001).
Conclusions: Esophageal motility is the main determining factor to determine the extent of wrap in fundoplication.
Partial posterior fundoplication provides an effective antireflux barrier in patients with impaired esophageal body motility.
Postoperative dysphagia is diminished, probably because of improved esophageal body function.

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