Journal of Gastrointestinal Surgery

, Volume 15, Issue 9, pp 1506–1512

Postoperative Impedance–pH Testing is Unreliable After Nissen Fundoplication With or Without Giant Hiatal Hernia Repair

  • Brittany N. Arnold
  • Christy M. Dunst
  • Angi B. Gill
  • Trudie A. Goers
  • Lee L. Swanström
2010 SSAT Poster Presentation

DOI: 10.1007/s11605-011-1597-4

Cite this article as:
Arnold, B.N., Dunst, C.M., Gill, A.B. et al. J Gastrointest Surg (2011) 15: 1506. doi:10.1007/s11605-011-1597-4

Abstract

Introduction

Combined 24-h multichannel intralumenal impedance–pH monitoring (MII-pH) is gaining popularity as a diagnostic tool for gastroesophageal reflux. Since the surgical reduction of hiatal hernias and creation of a fundoplication anatomically restores the gastroesophageal reflux barrier, one would assume that it effectively stops all reflux regardless of composition. Our aim is to evaluate the results of routine MII-pH testing in successful Nissen fundoplication patients.

Material and Methods

Sixty-two patients with normal acid exposure, confirmed by 24-h pH testing, after Nissen fundoplication were evaluated with symptomatic questionnaire, esophageal manometry and MII-pH testing more than 6 months after surgery. Patients were grouped into normal and abnormal based on postoperative impedance results. Patients with Nissen alone were separately compared to patients with Nissen + giant hiatal hernia (GHH).

Results

Twenty-nine (47%) patients exhibited abnormal impedance after successful Nissen fundoplication. Abnormal impedance was associated with GHH repair, lower bolus pressures, and lower distal esophageal contraction amplitudes.

Conclusion

Postoperative testing with the standard MII-pH catheters using published normative values seems to be clinically irrelevant. Clinicians should analyze the results of routine MII-pH testing in the setting of a fundoplication critically as the current technology is associated with a high false positive rate.

Keywords

Fundoplication Impedance MII-pH GERD 

Copyright information

© The Society for Surgery of the Alimentary Tract 2011

Authors and Affiliations

  • Brittany N. Arnold
    • 1
  • Christy M. Dunst
    • 1
  • Angi B. Gill
    • 1
  • Trudie A. Goers
    • 1
  • Lee L. Swanström
    • 1
  1. 1.Division of Gastrointestinal and Minimally Invasive SurgeryThe Oregon ClinicPortlandUSA

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