Objective outcomes of extra-esophageal symptoms following laparoscopic total fundoplication by means of combined multichannel intraluminal impedance pH-metry before and after surgery

Abstract

Identifying and treating patients with extra-esophageal symptoms is a challenge. When the patient is unable to control his symptoms with pharmacological therapy alone, anti-reflux surgery may be indicated. This study aims to evaluate the outcomes of total fundoplication in the resolution of extra-esophageal manifestations and verify changes in 24-h MII-pH monitoring before and after surgery. From October 2005 to October 2010, patients who reported respiratory symptoms, possibly related to GERD, have been sent to our Institute. All patients were practiced ambulatory 24-h MII-pH before and after surgery. Thirty-five patients selected for the antireflux surgery have undergone all the same surgical procedures. Data were collected prospectively at 6 and 12 months after laparoscopic fundoplication. After laparoscopic fundoplication, the total percentage of exposure time with esophageal pH < 4, and both in upright and supine position was very low. A statistically significant difference (p < 0.05) was found in the number of detected refluxes at MII and detected refluxes at MII 15-cm segment in pre and post-operative period. Symptom relief was obtained in all patients. Laparoscopic fundoplication is a safe and effective procedure to protect from refractory GERD and extra-esophageal symptoms, when evaluated with a thorough pre-operative selection.