Resumen

NAVARRETE, . Salvador et al. Implicaciones clínicas y terapéuticas de los cambios manométricos del esfínter esofágico inferior luego de funduplicaturas laparoscópicas . Gac Méd Caracas [online]. 2004, vol.112, n.1, pp.32-37. ISSN 0367-4762.

The purpose of the present work was to determine the manometric changes that are produced in the low esophageal sphincter after total and partial laparoscopic fundoplications in patients with gastroesophageal reflux disease, achalasia, and giant paraesophageal hiatal hernia; and to establish the relation of this changes with the disease control and postoperative complications. Among 42 patients operated 28 are included in the study (5 Nissen, 19 Toupet and 4 Dor) in which an esophageal manometry was practiced at 8 weeks of posoperative period. In the three kinds of fundoplications statistically significant elevations of low esophageal sphincter pressures was observed (Wilcoxon test), however there weren’t differences between the groups.All the patients with Nissen fundoplications had postoperative disfagia, and this didn’t occur in the cases with partial fundoplications.One patient with a Toupet fundoplication presented recurrence of the symptoms due to slipped wrap toward the mediastinum at two years of the operation. This required a new antireflux surgery practiced successfully by laparoscopy. All the remaining patients have reflux control without medication. We concluded that total and partial fundoplications produced enough pressure elevations in the low esophageal sphincter to control the reflux, however the first ones had the handicap of postoperative disfagia, reason why we recommend the Toupet procedure as the main option in patients with gastroesophageal reflux disease.

Palabras clave : Laparoscopic fundoplication; Esophageal manometry; Gastroesophageal reflux; Disfagia.