Journal of Gastrointestinal Surgery

, Volume 11, Issue 9, pp 1126–1133

Esophageal Manometry and Clinical Outcome After Laparoscopic Nissen Fundoplication

  • Huiqi Yang
  • David I. Watson
  • Jamie Kelly
  • Carolyn J. Lally
  • Jennifer C. Myers
  • Glyn G. Jamieson
Article

DOI: 10.1007/s11605-007-0224-x

Cite this article as:
Yang, H., Watson, D.I., Kelly, J. et al. J Gastrointest Surg (2007) 11: 1126. doi:10.1007/s11605-007-0224-x

Abstract

Introduction

The outcome after laparoscopic Nissen fundoplication can be assessed by either clinical symptoms or objective tests. Outcomes from objective tests are often held in higher regard than clinical data when determining the merits, or otherwise, of various antireflux surgery procedures. In this study, we sought to determine whether there is a relationship between postoperative symptoms and parameters measured by esophageal manometry to determine whether early postoperative esophageal manometry is a useful investigation for the routine assessment of post fundoplication outcome.

Methods

One hundred and forty-three patients who had undergone a laparoscopic Nissen fundoplication, clinical follow-up at 3 months and 5 years after surgery, and esophageal manometry at 3 months after fundoplication as part of routine follow-up in 1 of 5 clinical trials were studied. Nineteen of these patients also underwent manometry 5 years after fundoplication. Postoperative symptoms were prospectively determined by applying a standardized questionnaire, which assessed dysphagia, heartburn, bloat symptoms, and overall satisfaction using analog scales. Patients were classified into different groups according to the analog scores for clinical symptoms. Correlations between clinical and postoperative manometry outcomes were sought.

Results

No significant associations were found between parameters measured by esophageal manometry (lower esophageal sphincter resting and residual relaxation pressures, peristaltic amplitude and normal peristaltic propagation) and clinical parameters (dysphagia, heartburn, bloating, and overall satisfaction) for all time points—3 months postoperative manometry vs symptoms at 3 months and 5 years, 5 years postoperative manometry vs symptoms at 5 years, except for a weak (r = −0.17, p = 0.042) correlation between the percentage of successfully propagated swallows at 3 months and dysphagia for solids at 5 years.

Conclusion

Postoperative esophageal manometry parameters at 3 months and 5 years after surgery were not associated with any clinically important differences in the postoperative symptoms of heartburn, dysphagia, bloat or with overall satisfaction with the surgical outcome. The routine use of esophageal manometry to assess the outcome after Nissen fundoplication does not predict clinical outcome.

Keywords

Esophageal manometryClinical outcomeLaparoscopic Nissen fundoplication

Copyright information

© The Society for Surgery of the Alimentary Tract 2007

Authors and Affiliations

  • Huiqi Yang
    • 1
  • David I. Watson
    • 1
  • Jamie Kelly
    • 1
    • 2
  • Carolyn J. Lally
    • 1
    • 2
  • Jennifer C. Myers
    • 2
  • Glyn G. Jamieson
    • 2
  1. 1.Department of SurgeryFlinders University, Room 3D211, Flinders Medical CentreBedford Park, AdelaideAustralia
  2. 2.Royal Adelaide HospitalUniversity of Adelaide Discipline of SurgeryAdelaideAustralia