1 Revista do Colégio Brasileiro de Cirurgiões 1998 Vol: 25(4):. DOI: 10.1590/S0100-69911998000400005

Esofagomanometria e phmetria de 24 horas para avaliar a fundoplicatura de lind laparoscópica na doença do refluxo gastroesofágico

The recent introduction and widespread use of laparoscopic and thoracoscopic techniques has given a new dimension to esophageal functional surgery. A successful result depends on the documentation of esophageal disease as the cause of symptoms, the understanding of the cause of esophageal dysfunction, and the identification of patients who should have surgical treatment. This paper is a retrospective study developed in patients underwent Lind operation for gastroesophageal reflux. The study wants to establish the value of rotine use of esophageal manometry and 24 hour pH monitoring for selection and evaluation. Forty-one patients (68.3%) had mechanically defective lower esophageal sphincter. The preoperative pressure was 9.2 mmHg and postoperative 15.2 mmHg. The general increase was 6.0 mmHg, the increase in defective sphincters was 8.8 mmHg and in normal sphincters was 4.3. We found some diminished peristalsis of esophageal body in 14 patients (23.3%), and this group had four patients (28.5%) with improved peristalsis after surgery. Abnormal acid reflux was detected in 51 cases (85.0%) by pH monitoring. The preoperative DeMeester score was 31.4, decreasing to 3.2 at postoperative period. Esophageal manometry and 24 hour pH monitoring are efficient methods to detect and measure the functional modifications established with an antireflux procedure.

  1. Constantini M, DeMeester TR. Preoperative assessment of esophageal function. In: Modern Approach to Benign Esophageal Disease; Capo 2; Ed Lippincot-Raven; Philadelphia , (1997) .
  2. Lind JF, Duthie HL, Schleger JF, et al. Motility of the gastric fundus. Am J Physiol201 , 197-99 (1961) .
  3. Johnson LF, DeMeester TR. Development of 24 hour pH monitoring of de distal esophagus. Am J Gastrenterol 61 , 325-30 (1974) .
  4. Rafferty MD, Rattner DW. Gastroesophageal reflux disease: indications for surgery, preoperative evaluation, and choice of operation. Problems in General Surgery13 , 29-37 (1996) .
  5. Traube M. The spectrurn of symptorns and presentations of gastro-esophageal reflux disease. Gastroenterol Clin North Am 19 , 609-16 (1990) .
  6. Zaninotto RK, DeMeester TR, Schwizer W, et al. The lower esophageal sphincter and health disease. Am J Surg 155 , 104-11 (1988) .
  7. Kuster E, Ros D, Toledo-Pimental V, et al. Predictive factors of the long term outcome in gastro-esophageal reflux disease: six year follow up of 107 patients. Gut 35 , 8-14 (1994) .
  8. DeMeester TR, Bonavina L, Albertucci M. Nissen fundoplication for gastro-esophageal reflux disease - evaluation of primary repair in 100 consecutive patients. Ann Surg 204 , 9-20 (1986) .
  9. Crookes PF, Peters JH, DeMeester TR. Physiology of the antireflux barrier and diagnostic tests of foregut function. Sem Laparosc Surg 2 , 10-26 (1995) .
  10. Mittal RK, Holloway RH, Penagini R, et al. Transient lower sphincter relaxation. Gastroenterology109 , 601-610 (1995) .
  11. McNally EF, Kelly JF, Ingelfinger FJ. Mechanisms of belching: effects of gastric distension with air. Gastroenterology 46 , 254-259 (1964) .
  12. Dodds WJ, Dent J, Hogan WJ, et al. Mechanisms of gastroesophageal reflux in patients with reflux esophagitis. N Engl J Med 307:.1 , 547-52 (1982) .
  13. Mittal RK, McCallum RW. Characteristics and frequency of transient relaxations of the lower esophageal sphincter in patients with reflux esophagitis. Gastroenterology 95 , 593-9 (1988) .
  14. Karim SS, Pantom ON, Finley RJ, et al. Comparison of total vs. partial laparoscopic fundoplication in the management of gastroesophageal reflux disease. Am J Surg 173 , 375-78 (1997) .
  15. Thor KBA, Silander TA. A long-term randomized prospective trial of the Nissen procedure vs. a modified Toupet technique. Ann Surg , 210-719 (1989) .
  16. Constantini M, Crookes PF, Bremner RM, et al. Value of physiologic assesment of foregut symptoms in a surgical practice. Surgery 114 , 780-6 (1993) .
  17. Kahrilas PJ, Dodds WJ, Hogan WJ, et al. Esophageal peristaltic dysfunction in peptic esophagitis. Gastroenterology91 , 897-904 (1986) .
  18. Ottigmon Y, Pelissier EP, Maution G, et al. Reflux gastro-oesophagien. Comparison des resultats cliniques pH-metriques et manometriques des proceds de Nissen et de Toupet. Gastroenterol Clin Biol 18 , 920-6 (1994) .
  19. Johnson LF, DeMeester TR. Development of the 24 hour intra-esophageal pH monitoring composite score system. J Clin Gastroenterol 8 , 52-8 (1986) .
  20. Kasapidis P, Xynos E, Mantides A, et al. Differences in manometry and 24-h ambulatory pH-metry between patients with and without endoscopic or histological esophagitis in gastroesophageal reflux disease. Am J Gastroenterol 88 , 1893-9 (1993) .
  21. DeMeester TR, Wang CL, Wermly JA, et al. Technique, indications an clinical use of 24 hour esophageal pH monitoring. J Thorac Cardiovasc Surg 79 , 656-70 (1980) .
  22. DeMeester TR, Johnson LF. The evaluation of objective measurements of gastroesophageal reflux and their contribution to patient management. Surg Clin North Am 56 , 39-53 (1976) .
  23. Masclee AAM, De Best ACA, De Graf R, et al. Ambulatory 24-hour pH-metry in the diagnosis of gastroesophageal reflux disease. Scand J Gastroenterol 25 , 225-30 (1990) .
  24. Jamieson JR, Stein HJ, DeMeester TR, et al. Ambulatory 24 hour esophageal pH monitoring: normal values, optimal thresholds, specificity and reproducibility. Am J Gastroenterol 87: 1102- 1.111 , (1992) .