Journal of Gastrointestinal Surgery

, Volume 13, Issue 1, pp 61–65 | Cite as

Laparoscopic Fundoplication in Patients with a Hypertensive Lower Esophageal Sphincter

  • Peter J. Lamb
  • Jennifer C. Myers
  • Sarah K. Thompson
  • Glyn G. JamiesonEmail author
original article



A small proportion of patients evaluated with manometry prior to a fundoplication have a high-pressure lower esophageal sphincter (LES). This paper examines the outcome of laparoscopic fundoplication for these patients.

Material and Methods

Between October 1991 and December 2006, 1,886 patients underwent primary laparoscopic fundoplication. Those with a high-pressure LES on preoperative manometry (LESP ≥30 mm Hg at end expiration) were identified from a prospective database. Long-term outcomes were determined using analogue symptom scores (0–10) for heartburn, dysphagia, and patient satisfaction and compared to those of a matched control group.


Thirty patients (1.6%), nine men and 21 women, median age 51 years, had a hypertensive LES (mean, 36 mmHg; range, 30–55). Median follow-up after fundoplication was 99 (12–182) months. These patients had similar mean symptom scores to 30 matched controls for heartburn (2.3 vs. 2.2, P = 0.541), dysphagia (2.7 vs. 3.1, P = 0.539), and satisfaction (7.4 vs. 7.6, P = 0.546). Five patients required revision for dysphagia compared to no control patients (P = 0.005). These patients had a higher preoperative dysphagia score (6.6 vs. 3.1, P = 0.036).


Laparoscopic fundoplication can be performed with good long-term results for patients with reflux and a hypertensive LES. However, those with preoperative dysphagia have a higher failure rate.


Lower esophageal sphincter Antireflux surgery Gastroesophageal reflux 



The authors would like to acknowledge the invaluable assistance of Carolyn Lally, Janet Pinno, Lorelle Smith, and Nicky Ascott in obtaining follow-up data and maintaining the laparoscopic fundoplication database. We would also like to thank surgeons Peter G. Devitt and Philip A. Game from the Royal Adelaide Hospital and David I Watson and Justin Bessell from Flinders Medical Centre, Adelaide, for contributing patients to the database.


  1. 1.
    Code CF, Schlegel JF, Kelly ML, Olsen AM, Ellis FHG. Hypertensive gastroesophageal sphincter. Proc Mayo Clin 1960;35:391–399.Google Scholar
  2. 2.
    Spechler SJ, Castell DO. Classification of oesophageal motility abnormalities. Gut 2001;49:145–151. doi: 10.1136/gut.49.1.145.PubMedCrossRefGoogle Scholar
  3. 3.
    Tambankar AP, Almogy G, Arain M, Portale G, Hagen JA, Peters JH, et al. Surgical management of hypertensive lower esophageal sphincter with dysphagia or chest pain. J Gastrointest Surg 2003;7:990–996. doi: 10.1016/j.gassur.2003.09.003.CrossRefGoogle Scholar
  4. 4.
    Katada N, Hinder RA, Lund RJ, Perdikis J, Stalzer RA, McGinn TR. The hypertensive lower esophageal sphincter. Am J Surg 1996;172(5):439–442. doi: 10.1016/S0002-9610(96)00219-X.PubMedCrossRefGoogle Scholar
  5. 5.
    Varga G, Kiraly A, Cseke L, Kalmar K, Horvath OP. Effect of fundoplication on hypertensive lower esophageal sphincter associated with gastroesophageal reflux. J Gastrointest Surg 2008;12:304–307. doi: 10.1007/s11605-007-0397-3.PubMedCrossRefGoogle Scholar
  6. 6.
    Waterman DC, Dalton CB, Ott DJ, Castell JA, Bradley LA, Castell DO, et al. Hypertensive lower esophageal sphincter: what does it mean? J Clin Gastroenterol 1989;11(2):139–146. doi: 10.1097/00004836-198904000-00006.PubMedCrossRefGoogle Scholar
  7. 7.
    Jamieson GG, Maddern GJ. Long esophageal myotomy through the diaphragmatic hiatus in the treatment of hypertensive lower esophagus associated with gastroesophageal reflux. In Siewert JR, Holscher AH, eds. Diseases of the esophagus. Berlin, Germany: Springer, 1988, pp 918–20.Google Scholar
  8. 8.
    Katzka DA, Sidhu M, Castell DO. Hypertensive lower esophageal sphincter: an apparent paradox that is not unusual. Am J Gastroenterol 1995;90:280–284.PubMedGoogle Scholar
  9. 9.
    Gockel I, Lord RV, Bremner CG, Hamrah P, Demeester TR. The hypertensive lower esophageal sphincter: a motility disorder with manometric features of outflow obstruction. J Gastrointest Surg 2003;7(5):692–700. doi: 10.1016/S1091-255X(03)00043-X.PubMedCrossRefGoogle Scholar
  10. 10.
    Maddern G. The reproducibility of oesophageal manometry. Dis Esoph 1991;4:95–99.Google Scholar
  11. 11.
    Jamieson GG, Watson DI, Britten-Jones R, Mitchell PC, Anvari M. Laparoscopic Nissen fundoplication. Ann Surg 1994;220(2):137–145. doi: 10.1097/00000658-199408000-00004.PubMedCrossRefGoogle Scholar
  12. 12.
    Watson DI, Jamieson GG, Pike GK, Davies N, Richardson M, Devitt PG. Prospective randomized double-blind trial between laparoscopic Nissen fundoplication and anterior partial fundoplication. Br J Surg 1999;86(1):123–130. doi: 10.1046/j.1365-2168.1999.00969.x.PubMedCrossRefGoogle Scholar
  13. 13.
    Krysztopik RJ, Jamieson GG, Devitt PG, Watson DI. A further modification of fundoplication. 90 degrees anterior fundoplication. Surg Endosc 2002;16(10):1446–1451. doi: 10.1007/s00464-002-8801-2.PubMedCrossRefGoogle Scholar
  14. 14.
    Barreca M, Oelschlager BK, Pellegrini CA. Outcomes of laparoscopic fundoplication in patients with the ‘hypercontractile esophagus’. Arch Surg 2002;137:724–729. doi: 10.1001/archsurg.137.6.724.PubMedCrossRefGoogle Scholar
  15. 15.
    Blom D, Peters JH, Demeester TR, Crookes PF, Hagen JA, Demeester SR, et al. Physiologic mechanism and preoperative prediction of new onset dysphagia after laparoscopic Nissen fundoplication. J Gastrointest Surg 2002;6(1):22–27. doi: 10.1016/S1091-255X(01)00051-8.PubMedCrossRefGoogle Scholar
  16. 16.
    Kelly JJ, Watson DI, Chin KF, Devitt PG, Game PA, Jamieson GG. Laparoscopic Nissen fundoplication: clinical outcomes at 10 years. J Am Coll Surg 2007;205(4):570–575. doi: 10.1016/j.jamcollsurg.2007.05.024.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2008

Authors and Affiliations

  • Peter J. Lamb
    • 1
  • Jennifer C. Myers
    • 1
  • Sarah K. Thompson
    • 1
  • Glyn G. Jamieson
    • 1
    Email author
  1. 1.Discipline of SurgeryUniversity of AdelaideAdelaideAustralia

Personalised recommendations