Outcome of laparoscopic Nissen fundoplication in patients with disordered preoperative peristalsis

• Published in: Gut Vol. 40; no. 3; pp. 381 - 385
• Main Authors: Baigrie, R J, Watson, D I, Myers, J C, Jamieson, G G
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 01-03-1997; BMJ; BMJ Publishing Group LTD
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Esophagus; Esophagus - physiopathology; Female; Fundoplication; Gastroesophageal Reflux - physiopathology; Gastroesophageal Reflux - surgery; Humans; Male; Manometry; Medical sciences; Middle Aged; Peristalsis; Postoperative Period; Prospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Treatment Outcome; Human; Gastroesophageal reflux; Treatment; Surgery; Esophageal disease; Digestive diseases; Complication; Dysphagia; Nissen operation; Laparoscopy; Peristalsis
• ISSN: 0017-5749; 1468-3288; 1458-3288
• DOI: 10.1136/gut.40.3.381

BACKGROUND: A 360 degrees or Nissen fundoplication remains controversial in patients with disordered peristalsis, some surgeons preferring a partial wrap to minimise postoperative dysphagia. AIM: To evaluate symptoms and manometric outcome in patients with disordered peristalsis after Nissen fundoplication. PATIENTS: In an initial series of 345 patients studied prospectively, 31 patients who had undergone a Nissen fundoplication had disordered peristalsis. Using preoperative manometry, patients were classified as: equivocal primary peristalsis (eight patients); abnormal primary peristalsis (four patients); abnormal maximal contraction pressure (13 patients); abnormal primary peristalsis and maximal contraction pressure (six patients). METHODS: Postoperatively, patients underwent a barium meal, oesophageal manometry and standardised clinical review by a blinded scientific officer. RESULTS: Twenty eight (90%) patients had satisfaction scores of at least 8 out of a maximum of 10 and all would undergo surgery again. Whereas 15 (48%) patients had dysphagia scores greater than 4/10 preoperatively, only two (6%) had these scores at one year. Improved peristalsis was seen in 78% of postoperative manometric studies, and mean preoperative lower oesophageal sphincter pressure increased from 6.6 (range 0-21) mm Hg to 19 (4-50) mm Hg. CONCLUSIONS: These results are similar to the overall group of 345 patients and suggest that disordered peristalsis, and possibly even absent peristalsis, is not a contraindication to Nissen fundoplication as performed in these patients.