Laparoscopic antireflux surgery

Preoperative lower esophageal sphincter pressure does not affect outcome

M. G. Patti, S. Perretta, P. M. Fisichella, A. D'Avanzo, Carlos A Galvani, V. Gorodner, L. W. Way

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background: Concern has been raised about operating on patients with gastroesophageal reflux disease (GERD) and normal lower esophageal sphincter (LES) pressure for the fear that a fundoplication may fail to control reflux and result in a high rate of postoperative dysphagia. We hypothesized that fundoplication is effective in patients with GERD irrespective of the preoperative LES pressure, and that in patients with normal LES pressure, a total fundoplication does not result in a high incidence of dysphagia. Methods: We studied 280 unselected patients with GERD who underwent laparoscopic fundoplication. They were divided in three groups based on the preoperative LES pressure (normal, 14-24 mmHg): group A (LES pressure, 0-6 mmHg; 61 patients; 22%); group B (LES pressure, 7-13 mmHg; 178 patients; 64%); group C (LES pressure, ≥14 mmHg; 41 patients; 14%). De novo dysphagia was defined as new onset of postoperative dysphagia lasting more than 10 weeks. The average follow-up period was 17 ± 22 months. Results: There was no difference in resolution of symptoms among the three groups. Heartburn and regurgitation resolved or improved respectively in 96% of group A, 90% of group B, and 91% of group C patients. In addition, there was no difference in the incidence of de novo dysphagia, which occurred in 8% of group A, 7% of group B, and 2% of group C. Conclusions: We conclude that fundoplication controlled GERD irrespective of preoperative LES pressure, and that a normal LES pressure before surgery was not associated with a higher rate of postoperative dysphagia.

Original languageEnglish (US)
Pages (from-to)386-389
Number of pages4
JournalSurgical Endoscopy
Volume17
Issue number3
DOIs
StatePublished - Mar 1 2003
Externally publishedYes

Fingerprint

Lower Esophageal Sphincter
Laparoscopy
Fundoplication
Deglutition Disorders
Pressure
Gastroesophageal Reflux
Heartburn
Incidence
Fear

Keywords

  • Antireflux surgery
  • Dysphagia
  • Esophageal manometry
  • Gastroesophageal reflux
  • Lower esophageal sphincter

ASJC Scopus subject areas

  • Surgery

Cite this

Laparoscopic antireflux surgery : Preoperative lower esophageal sphincter pressure does not affect outcome. / Patti, M. G.; Perretta, S.; Fisichella, P. M.; D'Avanzo, A.; Galvani, Carlos A; Gorodner, V.; Way, L. W.

In: Surgical Endoscopy, Vol. 17, No. 3, 01.03.2003, p. 386-389.

Research output: Contribution to journalArticle

Patti, M. G. ; Perretta, S. ; Fisichella, P. M. ; D'Avanzo, A. ; Galvani, Carlos A ; Gorodner, V. ; Way, L. W. / Laparoscopic antireflux surgery : Preoperative lower esophageal sphincter pressure does not affect outcome. In: Surgical Endoscopy. 2003 ; Vol. 17, No. 3. pp. 386-389.
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abstract = "Background: Concern has been raised about operating on patients with gastroesophageal reflux disease (GERD) and normal lower esophageal sphincter (LES) pressure for the fear that a fundoplication may fail to control reflux and result in a high rate of postoperative dysphagia. We hypothesized that fundoplication is effective in patients with GERD irrespective of the preoperative LES pressure, and that in patients with normal LES pressure, a total fundoplication does not result in a high incidence of dysphagia. Methods: We studied 280 unselected patients with GERD who underwent laparoscopic fundoplication. They were divided in three groups based on the preoperative LES pressure (normal, 14-24 mmHg): group A (LES pressure, 0-6 mmHg; 61 patients; 22{\%}); group B (LES pressure, 7-13 mmHg; 178 patients; 64{\%}); group C (LES pressure, ≥14 mmHg; 41 patients; 14{\%}). De novo dysphagia was defined as new onset of postoperative dysphagia lasting more than 10 weeks. The average follow-up period was 17 ± 22 months. Results: There was no difference in resolution of symptoms among the three groups. Heartburn and regurgitation resolved or improved respectively in 96{\%} of group A, 90{\%} of group B, and 91{\%} of group C patients. In addition, there was no difference in the incidence of de novo dysphagia, which occurred in 8{\%} of group A, 7{\%} of group B, and 2{\%} of group C. Conclusions: We conclude that fundoplication controlled GERD irrespective of preoperative LES pressure, and that a normal LES pressure before surgery was not associated with a higher rate of postoperative dysphagia.",
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AU - Perretta, S.

AU - Fisichella, P. M.

AU - D'Avanzo, A.

AU - Galvani, Carlos A

AU - Gorodner, V.

AU - Way, L. W.

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AB - Background: Concern has been raised about operating on patients with gastroesophageal reflux disease (GERD) and normal lower esophageal sphincter (LES) pressure for the fear that a fundoplication may fail to control reflux and result in a high rate of postoperative dysphagia. We hypothesized that fundoplication is effective in patients with GERD irrespective of the preoperative LES pressure, and that in patients with normal LES pressure, a total fundoplication does not result in a high incidence of dysphagia. Methods: We studied 280 unselected patients with GERD who underwent laparoscopic fundoplication. They were divided in three groups based on the preoperative LES pressure (normal, 14-24 mmHg): group A (LES pressure, 0-6 mmHg; 61 patients; 22%); group B (LES pressure, 7-13 mmHg; 178 patients; 64%); group C (LES pressure, ≥14 mmHg; 41 patients; 14%). De novo dysphagia was defined as new onset of postoperative dysphagia lasting more than 10 weeks. The average follow-up period was 17 ± 22 months. Results: There was no difference in resolution of symptoms among the three groups. Heartburn and regurgitation resolved or improved respectively in 96% of group A, 90% of group B, and 91% of group C patients. In addition, there was no difference in the incidence of de novo dysphagia, which occurred in 8% of group A, 7% of group B, and 2% of group C. Conclusions: We conclude that fundoplication controlled GERD irrespective of preoperative LES pressure, and that a normal LES pressure before surgery was not associated with a higher rate of postoperative dysphagia.

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