Severely disordered.pdfVIP

Severely disordered esophageal peristalsis is not a contraindication to laparoscopic Nissen fundoplication Y. W. Novitsky,1,2 J. Wong,2,3 K. W. Kercher,1,2 D. E. M. Litwin,2 L. L. Swanstrom,3 B. T. Heniford1 1 Department of Surgery, Carolinas Medical Center, 1000 Blythe Boulevard, MEB 601, Charlotte, NC, 28202, USA 2 Department of Surgery, University of Massachusetts Medical Center, 55 Lake Avenue North, Worcester, MA, 01655, USA 3 Department of Minimally Invasive Surgery, Legacy Health System, 2801 N Gantenbein, Portland, OR, 97227, USA Received: 25 September 2006/Accepted: 20 November 2006/Online publication: 20 December 2006 Abstract Background: Laparoscopic Nissen fundoplication (LNF) is the preferred operation for the control of gastroesophageal reflux disease (GERD). The use of a full fundoplication for patients with esophageal dysmotility is controversial. Although LNF is known to be superior to a partial wrap for patients with weak peristalsis, its efficacy for patients with severe dysmo- tility is unknown. We hypothesized that LNF is also acceptable for patients with severe esophageal dysmo- tility. Methods: A multicenter retrospective review of consec- utive patients with severe esophageal dysmotility who underwent an LNF was performed. Severe dysmotility was defined by manometry showing an esophageal amplitude of 30 mmHg or less and/or 70% or more nonperistaltic esophageal body contractions. Results: In this study, 48 patients with severe esophageal dysmotility underwent LNF. All the patients presented with symptoms of GERD, and 19 (39%) had preoper- ative dysphagia. A total of 10 patients had impaired esophageal body contractions, whereas 32 patients had an abnormal esophageal amplitude, and 6 patients had both. The average abnormal esophageal amplitude was 24.9 ± 5.2 mmHg (range, 6.0–30 mmHg). The mean percentage of nonperistaltic esophageal body contrac- tions was 79.4% ± 8.3% (range, 70–100%). There were no intraoperative complications and no conversi