Esophageal pH Profile Following Laparoscopic Total Fundoplication Compared to Anterior Fundoplication
- 72 Downloads
In Barrett’s esophagus, total abolition of reflux may give maximum protection against the development of malignancy. To determine whether laparoscopic anterior fundoplication gives the same degree of antireflux control as a total fundoplication, we analyzed a prospectively followed cohort of patients from randomized controlled trials of laparoscopic antireflux surgery. There were 167 patients who returned for routine esophageal pH studies within 6 months of surgery (123 laparoscopic total fundoplications and 44 anterior fundoplications). There was no difference in percentage time pH <4 between fundoplication groups, but the total number of reflux episodes was significantly different (total fundoplication, four reflux events vs. partial fundoplication, six reflux events; p = 0.03). It is difficult to believe that this difference is either biologically or clinically important. In patients with a second esophageal pH study more than 5 years later, both the percentage time pH <4 (0.1% total fundoplication vs. 2.7% partial fundoplication; p = 0.004) and total number of reflux episodes (three total fundoplication vs. 24 partial fundoplication; p = 0.002) were significantly different. However, the postoperative esophageal acid exposure was within the normal range for both total and partial fundoplication, so whether the statistical difference is clinically important, remains a moot point.
KeywordsLaparoscopic fundoplication Gastro-esophageal reflux Esophageal pH monitoring Randomized controlled trial
We would like to thank Carolyn Lally for her help with the fundoplication database and Thomas Sullivan for his advice on statistical analysis.
- 2.Watson DI, Jamieson GG, Lally C, Archer S, Bessell JR, Booth M, Cade R, Cullingford G, Devitt PG, Fletcher DR, Hurley J, Kiroff G, Martin CJ, Martin IJ, Nathanson LK, Windsor JA. Multicenter, prospective, double-blind, randomized trial of laparoscopic nissen vs anterior 90 degrees partial fundoplication. Arch Surg 2004;139(11):1160–1167.PubMedCrossRefGoogle Scholar
- 7.Khajanchee Y, O’Rourke R, Lockhart B, Patterson E, Hansen P, Swanstrom L. Postoperative symptoms and failure after antireflux surgery. Archives of surgery (Chicago, IL: 1960) 2002;137(9):1008–1013. discussion 1013–1004.Google Scholar
- 9.Lord RV, Kaminski A, Oberg S, Bowrey DJ, Hagen JA, DeMeester SR, Sillin LF, Peters JH, Crookes PF, DeMeester TR. Absence of gastroesophageal reflux disease in a majority of patients taking acid suppression medications after Nissen fundoplication. J Gastrointest Surg 2002;6(1):3–9. discussion 10.PubMedCrossRefGoogle Scholar
- 11.DeMeester TR. Prolonged Oesophageal pH Monitoring. In Read NW, ed. Gastrointestinal motility: Which Test? UK: Wrightson Biomedical Publishing Ltd, 1989, pp 41–52.Google Scholar
- 19.Yau P, Watson D, Devitt P, Game P, Jamieson G. Laparoscopic antireflux surgery in the treatment of gastroesophageal reflux in patients with Barrett esophagus. Archives of surgery (Chicago, IL: 1960) 2000;135(7):801–805.Google Scholar