Videosurgery and Other Miniinvasive Techniques (Jun 2011)
Laparoscopic fundoplication improves oesophageal motility – a prospective study
Abstract
Introduction: In the presented series of a hundred consecutive cases the authors tried to assess objectively the efficacyof surgical treatment for gastroesophageal reflux disease.Aim: To assess the influence of the procedure on oesophageal motility and the lower oesophagus sphincter.Material and methods: Thirty-seven female and 63 male patients were qualified to participate in the study. Based onthe preoperative manometry results patients were qualified for laparoscopic complete fundoplication (Nissen procedure)or incomplete fundoplication (Toupet’s procedure). The control examination was performed one year after surgicaltreatment.Results: Taking into account the preoperative oesophageal manometry results, 67 Nissen fundoplications and33 Toupet’s fundoplications were performed. The mean age was 51.54 years. Postoperative mortality was 0%. Assessingthe oesophageal motility it was concluded that the values of particular parameters of the lower oesophagealsphincter (LES) – total length, length of the abdominal portion – increased significantly (p < 0.001) and the mean restingpressure in the LES increased statistically significantly independently of the operative method. A significant influenceof the procedure on the peristaltic contraction amplitude, its duration, percentage of non-peristaltic contractionsand the percentage of low-amplitude contractions was observed. The greatest changes of the clinically significantparameters – the percentage of low-amplitude contractions and the number of non-peristaltic contractions – wereobserved in the group of patients with impaired oesophageal motility. During the postoperative period a decrease ofthe percentage of low-amplitude contractions and an increase of peristaltic contractions were observed. Both parameterswere statistically significant.Conclusions: Antireflux procedures regardless of the technique used cause normalization of lower oesophagealsphincter function. All anatomical parameters of the lower oesophageal sphincter return to normal values. Followingthe antireflux procedures the oesophageal motility significantly improves clinically, especially in the group of patientswith impaired oesophageal motility.
