Are preoperative oesophageal pH and manometry studies necessary prior to laparoscopic nissen fundoplication?

Aims: The indications for use of preoperative ph and manometry studies prior to antireflux surgery vary. We have conducted a retrospective review to determine the usefulness of ph and manometry studies in patients considered for antireflux surgery.

Methods: All consecutive patients who underwent oesophageal ph manometry studies between 1999 and 2004 were included in the study. Data was collected by review of case notes.

Results: 91 patients underwent oesophageal manometry.83 patients underwent manometry for preoperative assessment before surgery,5 for chronic cough and globus,2 for dysphagia and one for non-cardiac chest pain.58 patients were suitable for laparoscopic nissen fundoplication.95% of those patients with oesophagitis were suitable for surgery by ph and manometry criteria. Only 49% of patients without oesophagitis and none of the patients with atypical symptoms were suitable for surgery. Overall 25 patients did not undergo surgery because of normal ph in 21 and motility disorders in 4. 90% of the patients who underwent surgery had symptom relief.

Conclusion: In patients being considered for antireflux surgery, ph and manometry studies are essential in those who have atypical symptoms or no oesophagitis. Ph and manometry studies are extremely unlikely to alter the decision to operate in patients with oesophagitis.