Surgical Endoscopy

, Volume 21, Issue 2, pp 285–288 | Cite as

Effect of partial and total laparoscopic fundoplication on esophageal body motility

  • F. A. M. Herbella
  • P. Tedesco
  • I. Nipomnick
  • P. M. Fisichella
  • M. G. PattiEmail author



Abnormal esophageal body motility often accompanies gastroesophageal reflux disease (GERD). Although the effect of surgery on the pressure and behavior of the lower esophageal sphincter (LES) has been extensively studied, it still is unclear whether a successful fundoplication improves esophageal peristalsis.


The pre- and postoperative esophageal manometries of 71 patients who underwent a successful laparoscopic fundoplication (postoperative DeMeester score < 14.7) were reviewed. The patients were grouped according to the type of fundoplication (partial vs total) and preoperative esophageal peristalsis (normal vs abnormal): group A (partial fundoplication and abnormal esophageal peristalsis; n = 16), group B (total fundoplication and normal peristalsis; n = 41), and group C (total fundoplication and abnormal peristalsis; n = 14).


The LES pressure was increased in all the groups. A significant increase in amplitude of peristalsis was noted in groups A and C. Normalization of peristalsis was achieved in 31% of the group A patients and 86% of the group C patients. No changes occurred in group B.


Laparoscopic fundoplication increased LES pressure and the strength of esophageal peristalsis in patients with abnormal preoperative esophageal motility. A total fundoplication resulted in normalization of peristalsis in the majority of patients.


Ambulatory pH monitoring Esophageal manometry Esophageal peristalsis Gastroesophageal reflux disease Laparoscopic fundoplication 



Dr. Fernando Herbella was supported by the Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior, Brazil.


  1. 1.
    Dallemagne B, Weerts J, Markiewicz S, Dewandre JM, Wahlen C, Monami B, Jehaes C (2006) Clinical results of laparoscopic fundoplication at ten years after surgery. Surg Endosc 20: 159–165CrossRefPubMedGoogle Scholar
  2. 2.
    Diener U, Patti MG, Molena D, Fisichella PM, Way LW (2001) Esophageal dysmotility and gastroesophageal reflux disease. J Gastrointest Surg 5: 260–265CrossRefPubMedGoogle Scholar
  3. 3.
    Dodds WJ, Dent J, Hogan WJ, Helm JF, Hauser R, Patel GK, Egide MS (1982) Mechanisms of gastroesophageal reflux in patients with reflux esophagitis. N Engl J Med 307: 1547–1552CrossRefPubMedGoogle Scholar
  4. 4.
    Eckardt VF (1988) Does healing of esophagitis improve esophageal motor function? Dig Dis Sci 33: 161–165CrossRefPubMedGoogle Scholar
  5. 5.
    Heider TR, Behrns KE, Koruda MJ, Shaheen NJ, Lucktong TA, Bradshaw B, Farrell TM (2003) Fundoplication improves disordered esophageal motility. J Gastrointest Surg 7: 159–163CrossRefPubMedGoogle Scholar
  6. 6.
    Horvath KD, Jobe BA, Herron DM, Swanstrom LL (1999) Laparoscopic Toupet fundoplication is an inadequate procedure for patients with severe reflux disease. J Gastrointest Surg 3: 583–591CrossRefPubMedGoogle Scholar
  7. 7.
    Jamieson JR, Stein HJ, DeMeester TR, Bonavina L, Schwizer W, Hinder RA, Albertucci M (1992) Ambulatory 24-h esophageal pH monitoring: normal values, optimal thresholds, specificity, sensitivity, and reproducibility. Am J Gastroenterol 87: 1102–1111PubMedGoogle Scholar
  8. 8.
    Johnsson F, Holloway RH, Ireland AC, Jamieson GG, Dent J (1997) Effect of fundoplication on transient lower oesophageal sphincter relaxation and gas reflux. Br J Surg 84: 686–689CrossRefPubMedGoogle Scholar
  9. 9.
    Kahrilas PJ, Dodds WJ, Hogan WJ (1988) Effect of peristaltic dysfunction on esophageal volume clearance. Gastroenterology 94: 73–80CrossRefPubMedGoogle Scholar
  10. 10.
    Kahrilas PJ, Dodds WJ, Hogan WJ, Kern M, Arndorfer RC, Reece A (1986) Esophageal peristaltic dysfunction in peptic esophagitis. Gastroenterology 91: 897–904CrossRefPubMedGoogle Scholar
  11. 11.
    Meneghetti AT, Tedesco P, Damani T, Patti MG (2005) Esophageal mucosal damage may promote dysmotility and worsen esophageal acid exposure. J Gastrointest Surg 9: 1313–1317CrossRefPubMedGoogle Scholar
  12. 12.
    Oleynikov D, Eubanks TR, Oelschlager BK, Pellegrini CA (2002) Total fundoplication is the operation of choice for patients with gastroesophageal reflux and defective peristalsis. Surg Endosc 16: 909–913CrossRefPubMedGoogle Scholar
  13. 13.
    Ortiz Escandell A, de Martinez Haro LF, Parrilla Paricio P, Aguayo Albasini JL, Garcia Marcilla JA, Morales Cuenca G (1991) Surgery improves defective oesophageal peristalsis in patients with gastroesophageal reflux. Br J Surg 78: 1095–1097CrossRefPubMedGoogle Scholar
  14. 14.
    Patti MG, Arcerito M, Feo CV, De Pinto M, Tong J, Gantert W, Tyrrell D, Way LW (1998) An analysis of operations for gastroesophageal reflux disease: identifying the important technical elements. Arch Surg 133: 600–606CrossRefPubMedGoogle Scholar
  15. 15.
    Patti MG, Diener U, Tamburini A, Molena D, Way LW (2001) Role of esophageal function tests in diagnosis of gastroesophageal reflux disease. Dig Dis Sci 46: 597–602CrossRefPubMedGoogle Scholar
  16. 16.
    Patti MG, Robinson T, Galvani C, Gorodner MV, Fisichella PM, Way LW (2004) Total fundoplication is superior to partial fundoplication even when esophageal peristalsis is weak. J Am Coll Surg 198: 863–869CrossRefPubMedGoogle Scholar
  17. 17.
    Ravi N, Al-Sarraf N, Moran T, O’riordan J, Rowley S, Byrne PJ, Reynolds JV (2005) Acid normalization and improved esophageal motility after Nissen fundoplication: equivalent outcomes in patients with normal and ineffective esophageal motility. Am J Surg 190: 445–450CrossRefPubMedGoogle Scholar
  18. 18.
    Rydberg L, Ruth M, Lundell L (1997) Does oesophageal motor function improve with time after successful antireflux surgery? Results of a prospective, randomised clinical study. Gut 41: 82–86CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Zaninotto G, DeMeester TR, Schwizer W, Johansson KE, Cheng SC (1988) The lower esophageal sphincter in health and disease. Am J Surg 155: 104–111CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • F. A. M. Herbella
    • 1
    • 2
  • P. Tedesco
    • 1
    • 2
  • I. Nipomnick
    • 1
    • 2
  • P. M. Fisichella
    • 1
    • 2
  • M. G. Patti
    • 1
    • 2
    Email author
  1. 1.Department of SurgeryUniversity of California San FranciscoSan FranciscoUSA
  2. 2.San FranciscoUSA

Personalised recommendations