Evaluation of the Role of Eosaphageal Manometry in Tailoring of Fundoplication Type in the Management of Hiatal Hernia | ||
| Ain Shams Journal of Surgery | ||
| Volume 17, Issue 2, April 2024, Pages 105-114 PDF (590.45 K) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/asjs.2024.351417 | ||
| Authors | ||
| Ebrahim Mokhtar Farag; Ashraf Kamal Abdallah; Ahmed Magdy Farrag | ||
| Department of General Surgery, Faculty of Medicine, Ain shams University, Egypt | ||
| Abstract | ||
| Introduction: An established surgical treatment for patients with hiatus hernia with gastroesophageal reflux disease (GERD) is laparoscopic fundoplication. In order to enhance reflux control while reducing negative postoperative troublesome side effects mainly dysphagia, high resolution esophageal manometry (HRM) is considered an essential step in preoperative evaluation. Aim of work: To examine the impact of preoperative high-resolution manometry (HRM) on determining the appropriate type and degree of fundoplication in patients with hiatus hernia, aiming to anticipate surgical outcomes, focusing particularly on the probability of postoperative dysphagia. The evaluation includes both a short-term (3-month) and a long-term (6-month) postoperative follow-up period. Patients and methods: 24 eligible patients with an established diagnosis of hiatal hernia were the total number of patients in our prospective clinical trial study at the General Surgery outpatient’s clinic, Ain-Shams University Hospitals, in the period from April 2022 until the end of October 2022. They were divided intentionally according to their preoperative high-resolution oesaphageal manometry results into two equal groups; the first 12 patients with oesophageal hypomotility underwent partial fundoplication. The other 12 having normal oesophageal motility underwent complete fundoplication. All the patients met the inclusion criteria. Exclusion criteria included: (a) pregnant and lactating females. (b) patients with a history of previous esophagogastric surgery. (c) Patients with achalasia. (d) patients who will refuse to participate in the study. (e) surgically unfit patients. Results: Regarding the difference between follow-up visits after 3 and 6 months among group 1 “partial fundoplication,” there was no statistically significant difference between them, i.e., no worsening of symptoms, where the following GERD, bloating, and dysphagia were reported in 0 (0%), 2 (16.7%), and 1 (8.3%), respectively, of patients at 3 months and in 0 (0%), 1 (8.3%), and 0 (0%) of patients at 6 months. difference between follow-up visits after 3 and 6 months among group 2 “complete fundoplication,” the following GERD, bloating, and dysphagia were reported in 0 (0%), 3 (25%), and 3 (25%), respectively, of patients at 3 months and in 0 (0%), 0 (0%), and 2 (16.7%), respectively, of patients at 6 months.No significant association was demonstrated between other preoperative HRM parameters and surgical outcomes. Conclusions: Preoperative esophageal manometry is a crucial step before deciding the type of fundic wrap fashioned as an antireflux procedure in patients with hiatus hernia. Inadequacy of lower esophageal sphincter (LES) relaxation with swallowing, indicated by high integrated relaxation pressure (IRP), or weak esophageal motility as shown by a low distal contractile integral (DCI), are key predictors of adverse long-term postoperative outcomes most importantly dysphagia. | ||
| Keywords | ||
| Dysphagia; Fundoplication; GERD; High resolution manometry; Nissen; Toupet | ||
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