Does laparoscopic antireflux surgery prevent the occurrence of transient lower esophageal sphincter relaxation?

  • F. Bahmeriz
  • S. Dutta
  • C. J. Allen
  • C. Gill Pottruff
  • M. Anvari
Original article


Background: Transient lower esophageal sphincter relaxation (TLESR) is the most common mechanism underlying gastroesophageal reflux disease (GERD), causing 70% to 100% of the reflux episodes in normal subjects and 63% to 74% of the reflux episodes in patients with reflux disease. This study aimed to evaluate the effect of laparoscopic Nissen fundoplication on TLESR in patients with proven GERD. Methods: We prospectively followed 73 consecutive patients (13 men and 60 women; mean age, 43.7 ± 1.72 years) with proven diagnosis of GERD and reported TLESRs found during a 40-min esophageal manometric study. These patients had repeat testing 6 months after undergoing laparoscopic Nissen fundoplication. Results: Laparoscopic Nissen fundoplication increased the basal and nadir lower esophageal sphincter (LES) pressure and significantly reduced the number of TLESRs during the manometric study. No patients after surgery exhibited TLESR with nadir less than 2 mmHg. However, 8 of the 73 patients (11%) exhibited TLESR to a nadir exceeding 50% of basal pressure (mean nadir, 5.0 ± 1.07 mmHg). Conclusions: The number of TLESRs is reduced significantly by antireflux surgery. Even accounting for increased basal and nadir pressures, the incidence of TLESR is reduced, suggesting that there may be additional mechanisms involved in this process.


Transient lower esophageal sphincter relaxation (TLESR) Laparoscopic fundoplication Gastroesophagcal reflux disease 


  1. 1.
    Allen, CJ, Parameswaram, K, Belda, J, Anvari, M 2000Reproducibility, validity, and responsiveness of a disease-specific symptom questionnaire for gastroesophageal reflux disease.Dis Esophagus13265270CrossRefPubMedGoogle Scholar
  2. 2.
    Anvari, M, Allen, C 1996Prospective evaluation of dysphagia before and after laparoscopic Nissen fundoplication without routine division of short gastrics.Surg Laparosc Endosc6424429CrossRefPubMedGoogle Scholar
  3. 3.
    Anvari, M, Allen, C 1998Esophageal and lower esophageal sphincter pressure profiles 6 and 24 months after laparoscopic fundoplication and their association with postoperative dysphagia.Surg Endosc12421426CrossRefPubMedGoogle Scholar
  4. 4.
    Anvari, M, Allen, C 1998Laparoscopic Nissen fundoplication: two-year comprehensive follow-up of a technique of minimal paraesophageal dissection.Ann Surg2272532CrossRefPubMedGoogle Scholar
  5. 5.
    Anvari, M, Allen, C, Borm, A 1995Laparoscopic Nissen fundoplication is a satisfactory alternative to long-term omeprazole therapy.Br J Surg82938942PubMedGoogle Scholar
  6. 6.
    Baldi, F, Longanesi, A, Ferrarini, F, Michieletti, G, Morselli-Labate, A 1992Oesophageal motor function and outcome of treatment with H2-blockers in erosive esophagitis.J Gastrointest Motil4165171Google Scholar
  7. 7.
    Cuschieri, A, Hunter, J, Wolfe, B, Swanstrom, LL, Hutson, W 1993Multicenter prospective evaluation of laparoscopic antireflux surgery: preliminary report.Surg Endosc7505510PubMedGoogle Scholar
  8. 8.
    Dallemagne, B, Weerts, JM, Jehaes, C 1991Laparoscopic Nissen fundoplication: preliminary report.Surg Laparosc Endosc3138143Google Scholar
  9. 9.
    Dent, J, Holloway, RH, Toouli, J, Dodds, WJ 1988Mechanisms of lower oesophageal sphincter incompetence in patients with symptomatic gastroesophageal reflux.Gut2910201028PubMedGoogle Scholar
  10. 10.
    Downton, J, Dent, J, Heddle, R, Toouli, J, Buckle, PJ, MacKinnon, AM, Wyman, JB 1987Elevation of gastric pH heals peptic esophagitis: a role for omeprazole.J Gastroenterol Hepatol2317324Google Scholar
  11. 11.
    Hinder, RA, Filipi, CJ, Wetscher, G, Neary, P, DeMeester, TR, Perdikis, G 1994Laparoscopic Nissen fundoplication is an effective treatment for gastroesophageal reflux disease.Ann Surg220472483PubMedGoogle Scholar
  12. 12.
    Holloway, RH 2001Systemic pharmacolmodulation of transient lower esophageal sphincter relaxations.Am J Med111178S185SCrossRefPubMedGoogle Scholar
  13. 13.
    Hunter, JG, ,Trus, TL, Branum, GD, Waring, JP, Wood, WC 1996A physiologic approach to laparoscopic fundoplication for gastroesophageal reflux disease.Ann Surg223673687PubMedGoogle Scholar
  14. 14.
    Ireland, AC, Holloway, RH, Toouli, J, Dent, J 1993Mechanisms underlying the antireflux action of fundoplication.Gut34303308PubMedGoogle Scholar
  15. 15.
    Jamieson, GG, Watson, DI, Britten-Jones, R, Mitchell, PC, Anvari, M 1994Laparoscopic Nissen fundoplication.Ann Surg220137145PubMedGoogle Scholar
  16. 16.
    Johnsson, F, Holloway, RH, Ireland, AC, Jamieson, GG, Dent, J 1997Effect of fundoplication on transient lower esophageal sphincter relaxation and gas reflux.Br J Surg84686689PubMedGoogle Scholar
  17. 17.
    Jones, R, Lydeard, S 1989Prevalence of symptoms of dyspepsia in the community.BMJ2983032PubMedGoogle Scholar
  18. 18.
    Lundell, L, Miettinen, P, Myrvold, HE, Pederen, SA, Liedman, B, Hatlebakk, JG, Julkonen, R, Levander, K, Carlsson, J, Lamm, M, Wiklund, I 2001Continued (5-year) follow-up of a randomized clinical study comparing antireflux surgery and omeprazole in gastroesophageal reflux disease.J Am Coll Surg192172181CrossRefPubMedGoogle Scholar
  19. 19.
    Massey, BT 2001Potential control of gastroesophageal reflux by local modulation of transient lower esophageal sphincter relaxations.Am J Med111186S189SCrossRefPubMedGoogle Scholar
  20. 20.
    Mittal, RK, Holloway, RH, Penagini, R, Blackshaw, LA, Dent, J 1995Transient lower esophageal sphincter relaxation.Gastroenterology109601610PubMedGoogle Scholar
  21. 21.
    Mittal, RK, McCallum, RE 1988Characteristics and frequency of transient relaxation of the lower esophageal sphincter on patient with reflux esophagitis.Gastroenterology95593599PubMedGoogle Scholar
  22. 22.
    Peters, JH, Heimbucher, J, Kauer, WK, Incarbone, R, Bremner, CG, DeMeester, TR 1995Clinical and physiologic comparison of laparoscopic and open Nissen fundoplication.J Am Coll Surg180385393PubMedGoogle Scholar
  23. 23.
    Pursnani, KG, Sataloff, DM, Zayas, F, Castell, DO 1997Evaluation of the antireflux mechanism following laparoscopic fundoplication.Br J Surg8411571161PubMedGoogle Scholar
  24. 24.
    Rydberg, L, Ruth, M, Lundell, L 1999Mechanism of action of antireflux procedures.Br J Surg86405410CrossRefPubMedGoogle Scholar
  25. 25.
    Spechler, SJ 1992Epidemiology and natural history of gastroesophageal reflux disease.Digestion512429PubMedGoogle Scholar
  26. 26.
    Watson, DI, Pike, GK, Baigrie, RJ, Mathew, G, Devitt, PG, Britten-Jones, R, Jamieson, GG 1997Prospective double-blind randomized trial of laparoscopic Nissen fundoplication with division and without division of short gastric vessels.Ann Surg226642652CrossRefPubMedGoogle Scholar
  27. 27.
    Weerts, JM, Dallemagne, B, Hamoir, E, Demarche, M, Markiewicz, S, Jehaes, C, Lombard, R, Demoulin, JC, Etienne, M, Ferron, PE 1993Laparoscopic Nissen fundoplication: detailed analysis of 132 patients.Surg Laparosc Endosc5359364Google Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • F. Bahmeriz
    • 1
  • S. Dutta
    • 1
  • C. J. Allen
    • 2
  • C. Gill Pottruff
    • 1
  • M. Anvari
    • 1
  1. 1.Department of Surgery, St. Joseph’s HealthcareMcMaster University, 50 Charlton Avenue East, Hamilton, OntarioCanada L8N 4A6
  2. 2.Department of Medicine, St. Joseph’s HealthcareMcMaster University, 50 Charlton Avenue East, Hamilton, OntarioCanada L8N 4A6

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