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 efficacy of 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 on the 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 surgical treatment. Results: Taking into account the preoperative oesophageal manometry results, 67 Nissen fundoplications and 33 Toupet's fundoplications were performed. The mean age was 51.54 years. Postoperative mortality was 0%. Assessing the oesophageal motility it was concluded that the values of particular parameters of the lower oesophageal sphincter (LES) - total length, length of the abdominal portion - increased significantly (p < 0.001) and the mean resting pressure in the LES increased statistically significantly independently of the operative method. A significant influence of the procedure on the peristaltic contraction amplitude, its duration, percentage of non-peristaltic contractions and the percentage of low-amplitude contractions was observed. The greatest changes of the clinically significant parameters - the percentage of low-amplitude contractions and the number of non-peristaltic contractions - were observed in the group of patients with impaired oesophageal motility. During the postoperative period a decrease of the percentage of low-amplitude contractions and an increase of peristaltic contractions were observed. Both parameters were statistically significant. Conclusions: Antireflux procedures regardless of the technique used cause normalization of lower oesophageal sphincter function. All anatomical parameters of the lower oesophageal sphincter return to normal values. Following the antireflux procedures the oesophageal motility significantly improves clinically, especially in the group of patients with impaired oesophageal motility.