Factors affecting the treatment outcomes of laparoscopic fundoplication for erosive reflux esophagitis: findings of esophageal pathological function tests

• Published in: Surgery today (Tokyo, Japan) Japan), 2021-10, Vol.51 (10), p.1568-1576
• Main Authors: Tsuboi, Kazuto, Yano, Fumiaki, Omura, Nobuo, Hoshino, Masato, Yamamoto, Se-Ryung, Akimoto, Shunsuke, Masuda, Takahiro, Sakashita, Yuki, Ikegami, Toru
• Format: Article
• Language: English
• Subjects: Adult; Aged; Cyclosporine; Esophagitis, Peptic - diagnosis; Esophagitis, Peptic - pathology; Esophagitis, Peptic - physiopathology; Esophagitis, Peptic - surgery; Esophagus - pathology; Esophagus - physiopathology; Female; Fundoplication - methods; Gastric Acidity Determination; Humans; Laparoscopy - methods; Male; Manometry - methods; Medicine; Medicine & Public Health; Middle Aged; Original Article; Surgery; Surgical Oncology; Treatment Outcome
• ISSN: 0941-1291; 1436-2813
• DOI: 10.1007/s00595-021-02226-4

Purpose To identify the factors that affect laparoscopic fundoplication (LF) treatment efficacy in patients with erosive gastroesophageal reflux disease (e-GERD) esophagitis, based on the findings of multichannel intraluminal impedance pH (MII-pH) and high-resolution manometry (HRM). Methods The subjects were 102 patients with e-GERD diagnosed by endoscopy, who underwent LF as the initial surgery. To analyze the findings of MII-pH and HRM, the patients were divided into two groups: a cured group (CR), comprised of patients whose esophagitis was cured postoperatively; and a recurrence group (RE), comprised of patients who suffered recurrent esophagitis. Results There were 96 patients in the CR group and 6 in the RE group. MII-pH indicated that the acid reflux time, the longest reflux time, and the number of refluxes longer than 5 min, were significantly higher in the RE group than in the CR group ( p  = 0.0028, p  = 0.0008, p  = 0.012, respectively). The HRM indicated that only the distal contractile integral (DCI) was significantly lower in the RE group ( p  = 0.0109). Conclusion The results of this study indicate that esophageal clearance may affect the treatment outcome of LF. Based on the findings of MII-pH, the longest reflux time and the number of refluxes longer than 5 min were important factors influencing the therapeutic effect, whereas based on the HRM, the DCI value was most important.