Effect of Laparoscopic Fundoplication on Hypertensive Lower Esophageal Sphincter Associated with Gastroesophageal Reflux

For hypertensive lower esophageal sphincter with dysphagia and chest pain, a laparoscopic cardiomyotomy is recommended. Recently, the role of gastroesophageal reflux in this abnormality has been recognized. A prospective study on six patients with manometrically proven hypertensive lower esophageal...

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Bibliographic Details
Published in:Journal of gastrointestinal surgery 2008-02, Vol.12 (2), p.304-307
Main Authors: Varga, Gabor, Kiraly, Agnes, Cseke, Laszlo, Kalmar, Katalin, Horvath, Ors Peter
Format: Article
Language:English
Subjects:
Adult
Aged
Digestive system
Esophageal Sphincter, Lower - physiopathology
Female
Fundoplication - methods
Gastroenterology
Gastroesophageal Reflux - physiopathology
Gastrointestinal diseases
Health care
Humans
Laparoscopy
Male
Manometry
Medical disorders
Medicine
Medicine & Public Health
Middle Aged
Original Article
Pressure
Surgery
Throat
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Summary:For hypertensive lower esophageal sphincter with dysphagia and chest pain, a laparoscopic cardiomyotomy is recommended. Recently, the role of gastroesophageal reflux in this abnormality has been recognized. A prospective study on six patients with manometrically proven hypertensive lower esophageal sphincter was performed. Laparoscopic floppy Nissen fundoplication was performed in all cases. The first follow up was performed 6 weeks after the operation. The mean follow up time was 56 months (range 50–61). Before the operation, all patients had abnormal esophageal acid exposure. Mean DeMeester score was 41.7 (range 16.7–86). Average LES pressure before the operation was 50.5 mmHg (range 35.6–81.3). Six weeks after operation, all patients were symptom free. DeMeester score returned to a normal level of 2.9. Furthermore, a marked decrease in the lower esophageal sphincter pressure (24.7 mmHg) was detected. At late follow up, all patients were symptom-free, and only two patients agreed to undergo functional testing. The mean DeMeester score of this two patients was 1.2. The pressure remained at normal value (15.7 mmHg). In our study, an antireflux operation normalized lower esophageal sphincter pressure suggesting that abnormal esophageal acid exposure may be an etiologic factor in the development of hypertensive lower esophageal sphincter.
ISSN:1091-255X
1873-4626
DOI:10.1007/s11605-007-0397-3