Laparoscopic fundoplication in patients with a hypertensive lower esophageal sphincter

J Gastrointest Surg. 2009 Jan;13(1):61-5. doi: 10.1007/s11605-008-0688-3. Epub 2008 Sep 7.

Abstract

Background: 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 > or = 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.

Results: 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).

Conclusion: 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.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Esophageal pH Monitoring
  • Esophagogastric Junction / metabolism
  • Esophagogastric Junction / physiopathology
  • Esophagogastric Junction / surgery*
  • Female
  • Follow-Up Studies
  • Fundoplication / methods*
  • Gastroesophageal Reflux / metabolism
  • Gastroesophageal Reflux / physiopathology
  • Gastroesophageal Reflux / surgery*
  • Humans
  • Laparoscopy*
  • Male
  • Manometry
  • Middle Aged
  • Muscle Contraction / physiology*
  • Patient Satisfaction
  • Pressure
  • Retrospective Studies
  • Time Factors
  • Treatment Outcome
  • Young Adult