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Erschienen in: Esophagus 2/2021

30.07.2020 | Original Article

Changes in esophageal physiology after paraesophageal hernia repair and Collis gastroplasty

verfasst von: Prashanthi N. Thota, Sonika Malik, Sampurna Shakya, Mythri AnilKumar, Scott Gabbard, Madhusudhan R. Sanaka, Thomas Rice, Siva Raja, Sudish Murthy, Rocio Lopez

Erschienen in: Esophagus | Ausgabe 2/2021

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Abstract

Background

The surgical approach and technique for paraesophageal hernia (PEH) repair is much debated. The changes in the esophageal physiology after PEH repair with a concomitant Collis gastroplasty (PEH-CG) are not clearly known. The aim of this study was to determine the changes in high resolution esophageal manometry (HREM) and esophageal pH testing after PEH-CG.

Methods

Retrospective analysis of all patients who underwent PEH-CG at our institution between 2006 and 2013 was performed. Patients had esophageal pH testing, HREM, barium swallow and an upper endoscopy before and after PEH-CG.

Results

A total of 182 patients underwent PEH-CG during the study period. Majority of patients had Nissen fundoplication (176, 96.7%) with Toupet in 6 (3.3%). Basal lower esophageal sphincter pressure (LESP) was lower after fundoplication (20.3 mmHg ± 11.3 vs. 25.8 mmHg ± 15.6, p < 0.001), whereas residual LESP was noted to be higher after fundoplication (7.7 mmHg ± 4.9 vs. 6.1 mmHg ± 6.7, p < 0.009). There were no significant changes in the esophageal motility patterns. There was an improvement in total pH and upright pH but not supine pH post PEH-CG. Normalization of total acid exposure after fundoplication was noted in 31 (59.6%) of the 52 patients who had abnormal total acid exposure prior to fundoplication.

Conclusions

Objective clinical assessment in patients undergoing PEH-CG demonstrates an effective operation for this complex problem. There was an increase in residual LESP but interestingly, decrease in basal LESP. Additionally, there was an improvement in esophageal acid exposure afterwards. These findings will facilitate future management of PEH.
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Metadaten
Titel
Changes in esophageal physiology after paraesophageal hernia repair and Collis gastroplasty
verfasst von
Prashanthi N. Thota
Sonika Malik
Sampurna Shakya
Mythri AnilKumar
Scott Gabbard
Madhusudhan R. Sanaka
Thomas Rice
Siva Raja
Sudish Murthy
Rocio Lopez
Publikationsdatum
30.07.2020
Verlag
Springer Singapore
Erschienen in
Esophagus / Ausgabe 2/2021
Print ISSN: 1612-9059
Elektronische ISSN: 1612-9067
DOI
https://doi.org/10.1007/s10388-020-00766-1

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