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Esophageal Manometry and Clinical Outcome After Laparoscopic Nissen Fundoplication

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

The outcome after laparoscopic Nissen fundoplication can be assessed by either clinical symptoms or objective tests. Outcomes from objective tests are often held in higher regard than clinical data when determining the merits, or otherwise, of various antireflux surgery procedures. In this study, we sought to determine whether there is a relationship between postoperative symptoms and parameters measured by esophageal manometry to determine whether early postoperative esophageal manometry is a useful investigation for the routine assessment of post fundoplication outcome.

Methods

One hundred and forty-three patients who had undergone a laparoscopic Nissen fundoplication, clinical follow-up at 3 months and 5 years after surgery, and esophageal manometry at 3 months after fundoplication as part of routine follow-up in 1 of 5 clinical trials were studied. Nineteen of these patients also underwent manometry 5 years after fundoplication. Postoperative symptoms were prospectively determined by applying a standardized questionnaire, which assessed dysphagia, heartburn, bloat symptoms, and overall satisfaction using analog scales. Patients were classified into different groups according to the analog scores for clinical symptoms. Correlations between clinical and postoperative manometry outcomes were sought.

Results

No significant associations were found between parameters measured by esophageal manometry (lower esophageal sphincter resting and residual relaxation pressures, peristaltic amplitude and normal peristaltic propagation) and clinical parameters (dysphagia, heartburn, bloating, and overall satisfaction) for all time points—3 months postoperative manometry vs symptoms at 3 months and 5 years, 5 years postoperative manometry vs symptoms at 5 years, except for a weak (r = −0.17, p = 0.042) correlation between the percentage of successfully propagated swallows at 3 months and dysphagia for solids at 5 years.

Conclusion

Postoperative esophageal manometry parameters at 3 months and 5 years after surgery were not associated with any clinically important differences in the postoperative symptoms of heartburn, dysphagia, bloat or with overall satisfaction with the surgical outcome. The routine use of esophageal manometry to assess the outcome after Nissen fundoplication does not predict clinical outcome.

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Authors and Affiliations

  1. Department of Surgery, Flinders University, Room 3D211, Flinders Medical Centre, Bedford Park, Adelaide, SA, 5042, Australia

    Huiqi Yang, David I. Watson, Jamie Kelly & Carolyn J. Lally

  2. Royal Adelaide Hospital, University of Adelaide Discipline of Surgery, Adelaide, SA, Australia

    Jamie Kelly, Carolyn J. Lally, Jennifer C. Myers & Glyn G. Jamieson

Authors
  1. Huiqi Yang
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  2. David I. Watson
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  3. Jamie Kelly
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  4. Carolyn J. Lally
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  5. Jennifer C. Myers
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  6. Glyn G. Jamieson
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Corresponding author

Correspondence to David I. Watson.

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Yang, H., Watson, D.I., Kelly, J. et al. Esophageal Manometry and Clinical Outcome After Laparoscopic Nissen Fundoplication. J Gastrointest Surg 11, 1126–1133 (2007). https://doi.org/10.1007/s11605-007-0224-x

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  • DOI: https://doi.org/10.1007/s11605-007-0224-x

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