High Resolution Manometry in a Functioning Fundoplication - Establishing a Standard Profile Retrospective Chart Review

Objective:The aim of this study was to provide a full HRM data set in patients with a normal functioning fundoplication. Background:The Chicago classification was devised to correlate HRM values to the clinical status of patients with swallowing disorder. However, it is unclear whether those values are applicable after fundoplication as the literature is sparse. Methods:We identified patients with pre- and postoperative HRM who had a normal functioning primary fundoplication as defined by (1) resolution of preoperative symptoms without significant postoperative side effects, (2) no dysphagia reported on a standardized questionnaire given on the day of the postoperative HRM and (3) normal acid exposure determined objectively by esophageal pH-testing. Results:Fifty patients met inclusion criteria for the study. Thirty-three patients (66%) underwent complete fundoplication and 17 patients (34%) underwent posterior partial fundoplication. Postoperative HRM was performed at a median of 12 months after primary surgery. Lower esophageal sphincter (LES) values significantly increased with the addition of a fundoplication. Median integrated relaxation pressure (IRP) was 14 mm Hg (P = 0.0001), median resting pressure 19.5 mm Hg (P = 0.0263), and median total length LES was 3.95 cm (P = 0.0098). The 95th percentile for IRP in a complete fundoplication was 29 versus 23 mm Hg in a partial fundoplication (P = 0.3667). Conclusion:We offer a new standard manometric profile for a normally functioning fundoplication which provides a necessary benchmark for analyzing postoperative problems with a fundoplication. The previously acceptedupper limit defining esophageal outflow obstruction (IRP >20 mm Hg) is not clinically applicable after fundoplication as the majority of patients in this dysphagia-free cohort exceeded this value. Interestingly, there does not seem to be a significant difference in HRM LES values between complete and partial fundoplication.

Automated summary

The aim of this study was to provide a complete set of HRM data for patients with a normally functioning fundoplication. The results showed that the addition of a fundoplication significantly increased the values of the lower esophageal sphincter. The previously accepted upper limit defining esophageal outflow obstruction may not be clinically applicable after fundoplication.