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Changes in esophageal physiology after paraesophageal hernia repair and Collis gastroplasty

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Abstract

Background

The surgical approach and technique for paraesophageal hernia (PEH) repair is much debated. The changes in the esophageal physiology after PEH repair with a concomitant Collis gastroplasty (PEH-CG) are not clearly known. The aim of this study was to determine the changes in high resolution esophageal manometry (HREM) and esophageal pH testing after PEH-CG.

Methods

Retrospective analysis of all patients who underwent PEH-CG at our institution between 2006 and 2013 was performed. Patients had esophageal pH testing, HREM, barium swallow and an upper endoscopy before and after PEH-CG.

Results

A total of 182 patients underwent PEH-CG during the study period. Majority of patients had Nissen fundoplication (176, 96.7%) with Toupet in 6 (3.3%). Basal lower esophageal sphincter pressure (LESP) was lower after fundoplication (20.3 mmHg ± 11.3 vs. 25.8 mmHg ± 15.6, p < 0.001), whereas residual LESP was noted to be higher after fundoplication (7.7 mmHg ± 4.9 vs. 6.1 mmHg ± 6.7, p < 0.009). There were no significant changes in the esophageal motility patterns. There was an improvement in total pH and upright pH but not supine pH post PEH-CG. Normalization of total acid exposure after fundoplication was noted in 31 (59.6%) of the 52 patients who had abnormal total acid exposure prior to fundoplication.

Conclusions

Objective clinical assessment in patients undergoing PEH-CG demonstrates an effective operation for this complex problem. There was an increase in residual LESP but interestingly, decrease in basal LESP. Additionally, there was an improvement in esophageal acid exposure afterwards. These findings will facilitate future management of PEH.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA

    Prashanthi N. Thota, Sonika Malik, Sampurna Shakya, Mythri AnilKumar, Scott Gabbard & Madhusudhan R. Sanaka

  2. Department of Thoracic Surgery, Cleveland Clinic, Cleveland, OH, USA

    Thomas Rice, Siva Raja & Sudish Murthy

  3. Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA

    Rocio Lopez

Authors
  1. Prashanthi N. Thota
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  2. Sonika Malik
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  3. Sampurna Shakya
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  4. Mythri AnilKumar
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  9. Sudish Murthy
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Contributions

SM, SS and MA: contributed to the data collection, study concept and design, drafting and critical revision of the manuscript; SG, TR, SR, SM: contributed to the study concept and design and critical revision of the manuscript; RL: contributed to data analysis, data interpretation and critical revision of the manuscript; PT: contributed to study concept and design, interpretation of data, drafting of the manuscript, critical revision of the manuscript and supervision of the study. All authors read and approved the final draft. All authors agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Prashanthi N. Thota.

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Ethical statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent or substitute for it was obtained from all patients for being included in the study.

Conflict of interest

Prashanthi N. Thota, Sonika Malik, Sampurna Shakya, Mythri AnilKumar, Scott Gabbard, Madhusudhan R. Sanaka, Thomas Rice, Siva Raja, Sudish Murthy, Rocio Lopez have no conflicts of interest or financial ties to disclose.

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Thota, P.N., Malik, S., Shakya, S. et al. Changes in esophageal physiology after paraesophageal hernia repair and Collis gastroplasty. Esophagus 18, 339–345 (2021). https://doi.org/10.1007/s10388-020-00766-1

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  • DOI: https://doi.org/10.1007/s10388-020-00766-1

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