Top

Journal of Gastrointestinal Surgery

Published in:

01-01-2009 | original article

Laparoscopic Fundoplication in Patients with a Hypertensive Lower Esophageal Sphincter

Authors: Peter J. Lamb, Jennifer C. Myers, Sarah K. Thompson, Glyn G. Jamieson

Published in: Journal of Gastrointestinal Surgery | Issue 1/2009

Abstract

Background

A small proportion of patients evaluated with manometry prior to a fundoplication have a high-pressure lower esophageal sphincter (LES). This paper examines the outcome of laparoscopic fundoplication for these patients.

Material and Methods

Between October 1991 and December 2006, 1,886 patients underwent primary laparoscopic fundoplication. Those with a high-pressure LES on preoperative manometry (LESP ≥30 mm Hg at end expiration) were identified from a prospective database. Long-term outcomes were determined using analogue symptom scores (0–10) for heartburn, dysphagia, and patient satisfaction and compared to those of a matched control group.

Results

Thirty patients (1.6%), nine men and 21 women, median age 51 years, had a hypertensive LES (mean, 36 mmHg; range, 30–55). Median follow-up after fundoplication was 99 (12–182) months. These patients had similar mean symptom scores to 30 matched controls for heartburn (2.3 vs. 2.2, P = 0.541), dysphagia (2.7 vs. 3.1, P = 0.539), and satisfaction (7.4 vs. 7.6, P = 0.546). Five patients required revision for dysphagia compared to no control patients (P = 0.005). These patients had a higher preoperative dysphagia score (6.6 vs. 3.1, P = 0.036).

Conclusion

Laparoscopic fundoplication can be performed with good long-term results for patients with reflux and a hypertensive LES. However, those with preoperative dysphagia have a higher failure rate.

Code CF, Schlegel JF, Kelly ML, Olsen AM, Ellis FHG. Hypertensive gastroesophageal sphincter. Proc Mayo Clin 1960;35:391–399.

Spechler SJ, Castell DO. Classification of oesophageal motility abnormalities. Gut 2001;49:145–151. doi:10.1136/gut.49.1.145.PubMedCrossRef

Tambankar AP, Almogy G, Arain M, Portale G, Hagen JA, Peters JH, et al. Surgical management of hypertensive lower esophageal sphincter with dysphagia or chest pain. J Gastrointest Surg 2003;7:990–996. doi:10.1016/j.gassur.2003.09.003.CrossRef

Katada N, Hinder RA, Lund RJ, Perdikis J, Stalzer RA, McGinn TR. The hypertensive lower esophageal sphincter. Am J Surg 1996;172(5):439–442. doi:10.1016/S0002-9610(96)00219-X.PubMedCrossRef

Varga G, Kiraly A, Cseke L, Kalmar K, Horvath OP. Effect of fundoplication on hypertensive lower esophageal sphincter associated with gastroesophageal reflux. J Gastrointest Surg 2008;12:304–307. doi:10.1007/s11605-007-0397-3.PubMedCrossRef

Waterman DC, Dalton CB, Ott DJ, Castell JA, Bradley LA, Castell DO, et al. Hypertensive lower esophageal sphincter: what does it mean? J Clin Gastroenterol 1989;11(2):139–146. doi:10.1097/00004836-198904000-00006.PubMedCrossRef

Jamieson GG, Maddern GJ. Long esophageal myotomy through the diaphragmatic hiatus in the treatment of hypertensive lower esophagus associated with gastroesophageal reflux. In Siewert JR, Holscher AH, eds. Diseases of the esophagus. Berlin, Germany: Springer, 1988, pp 918–20.

Katzka DA, Sidhu M, Castell DO. Hypertensive lower esophageal sphincter: an apparent paradox that is not unusual. Am J Gastroenterol 1995;90:280–284.PubMed

Gockel I, Lord RV, Bremner CG, Hamrah P, Demeester TR. The hypertensive lower esophageal sphincter: a motility disorder with manometric features of outflow obstruction. J Gastrointest Surg 2003;7(5):692–700. doi:10.1016/S1091-255X(03)00043-X.PubMedCrossRef

10.

Maddern G. The reproducibility of oesophageal manometry. Dis Esoph 1991;4:95–99.

11.

Jamieson GG, Watson DI, Britten-Jones R, Mitchell PC, Anvari M. Laparoscopic Nissen fundoplication. Ann Surg 1994;220(2):137–145. doi:10.1097/00000658-199408000-00004.PubMedCrossRef

12.

Watson DI, Jamieson GG, Pike GK, Davies N, Richardson M, Devitt PG. Prospective randomized double-blind trial between laparoscopic Nissen fundoplication and anterior partial fundoplication. Br J Surg 1999;86(1):123–130. doi:10.1046/j.1365-2168.1999.00969.x.PubMedCrossRef

13.

Krysztopik RJ, Jamieson GG, Devitt PG, Watson DI. A further modification of fundoplication. 90 degrees anterior fundoplication. Surg Endosc 2002;16(10):1446–1451. doi:10.1007/s00464-002-8801-2.PubMedCrossRef

14.

Barreca M, Oelschlager BK, Pellegrini CA. Outcomes of laparoscopic fundoplication in patients with the ‘hypercontractile esophagus’. Arch Surg 2002;137:724–729. doi:10.1001/archsurg.137.6.724.PubMedCrossRef

15.

Blom D, Peters JH, Demeester TR, Crookes PF, Hagen JA, Demeester SR, et al. Physiologic mechanism and preoperative prediction of new onset dysphagia after laparoscopic Nissen fundoplication. J Gastrointest Surg 2002;6(1):22–27. doi:10.1016/S1091-255X(01)00051-8.PubMedCrossRef

16.

Kelly JJ, Watson DI, Chin KF, Devitt PG, Game PA, Jamieson GG. Laparoscopic Nissen fundoplication: clinical outcomes at 10 years. J Am Coll Surg 2007;205(4):570–575. doi:10.1016/j.jamcollsurg.2007.05.024.PubMedCrossRef

Title: Laparoscopic Fundoplication in Patients with a Hypertensive Lower Esophageal Sphincter
Authors: Peter J. Lamb
Jennifer C. Myers
Sarah K. Thompson
Glyn G. Jamieson
Publication date: 01-01-2009
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 1/2009
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-008-0688-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Laparoscopic Fundoplication in Patients with a Hypertensive Lower Esophageal Sphincter

Abstract

Background

Material and Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Material and Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2009

Giant Trichobezoar and Gastric Perforation in a Normal Healthy Woman

Surgical Resection Versus Palliative Chemoradiotherapy for the Management of Pancreatic Cancer with Local Venous Invasion: A Decision Analysis

Safety in the OR: Who’s in and Who’s out?

Prevention and Management of Pancreatic Fistula

An Improved Method of Assessing Esophageal Emptying Using the Timed Barium Study Following Surgical Myotomy for Achalasia

Transumbilical Gelport Access Technique for Performing Single Incision Laparoscopic Surgery (SILS)