BACKGROUND: The value of esophageal manometry and ambulatory pH monitoring before laparoscopic antireflux surgery (LARS) has been questioned because tailoring the operation to the degree of hypomotility often is not required. This study evaluated a consecutive cohort of patients referred for esophageal function studies in preparation for LARS to determine the rates of findings that would alter surgical decisions. METHODS: High-resolution manometry (HRM) was performed for each subject using a 21-lumen water-perfused system, and motor function was characterized. Gastroesophageal reflux disease (GERD) was evident from ambulatory pH monitoring if thresholds for acid exposure time and/or positive symptom association probability were passed. RESULTS: Of 1,081 subjects (age, 48.4 +/- 0.4 years; 56.7% female) undergoing preoperative HRM, 723 (66.9%) also had ambulatory pH testing performed. Lower esophageal sphincter (LES) hypotension (38.9%) and nonspecific spastic disorder (NSSD) of the esophageal body (36.1%) were common. Obstructive LES pathophysiology was noted in 2.5% (achalasia in 1%; incomplete LES relaxation in 1.5%), and significant esophageal body hypomotility in 4.5% (aperistalsis in 3.2%; severe hypomotility in 1.3%) of the subjects. Evidence of GERD was absent in 23.9% of the subjects. Spastic disorders were more frequent in the absence of GERD (43.9% vs. 23.1% with GERD; p < 0.0001), whereas hypomotility and normal patterns were more common with GERD. CONCLUSIONS: Findings considered absolute or relative contraindications for standard 360 masculine fundoplication are detected in 1 of 14 patients receiving preoperative HRM. Additionally, spastic findings associated with persistent postoperative symptoms are detected at esophageal function testing that could be used in preoperative counseling and candidate selection. Physiologic testing remains important in the preoperative evaluation of patients being considered for LARS.
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机译：背景：腹腔镜抗反流手术（LARS）之前食管测压和动态pH监测的价值受到质疑，因为通常不需要根据低运动性程度调整手术。这项研究评估了连续的接受食管功能研究的患者队列，以准备进行LARS，以确定可改变手术决策的发现率。方法：采用21腔水灌注系统对每位受试者进行高分辨率测压（HRM），并表征运动功能。如果通过了酸暴露时间和/或阳性症状关联概率的阈值，则通过动态pH监测可明显发现胃食管反流病（GERD）。结果：在接受手术前HRM的1,081名受试者（年龄，48.4 +/- 0.4岁;女性56.7％）中，有723名（66.9％）接受了动态pH测试。食管体下段食管括约肌（LES）低血压（38.9％）和非特异性痉挛性疾病（NSSD）（36.1％）很常见。受试者的梗阻性LES病理生理学为2.5％（失语症为1％; LES不完全放松为1.5％），食管明显的动力不足为4.5％（蠕动为3.2％;严重动力不足为1.3％）。在23.9％的受试者中没有GERD证据。在没有GERD的情况下痉挛性疾病更为常见（43.9％比GERD的23.1％; p <0.0001），而GERD的运动能力减退和正常模式更为常见。结论：在接受术前HRM的14例患者中，有1例发现了标准360男性胃底折叠术的绝对或相对禁忌症。此外，在食管功能测试中检测到与持续的术后症状相关的痉挛性发现，可用于术前咨询和候选人选择。在对考虑接受LARS的患者进行术前评估时，生理测试仍然很重要。
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