Khajanchee YS, Hong D, Hansen PD, Swanstrom LL. Outcomes of antireflux surgery in patients with normal preoperative 24-hour pH test results. Am J Surg. – 2004 May. – 187(5):599-603.B

Популярно о болезнях ЖКТ Лекарства при болезнях ЖКТ Если лечение не помогает Адреса клиник

Авторы: Khajanchee YS / Hong D. / Hansen P.D. / Swanstrom LL


Outcomes of antireflux surgery in patients with normal preoperative 24-hour pH test results

Khajanchee YS, Hong D, Hansen PD, Swanstrom LL.




OBJECTIVE: Preoperative 24-hour pH testing is controversial in surgical patients who have symptomatic gastroesophageal reflux disease (GERD) and endoscopic evidence of esophagitis.

The objective of this study was to compare the clinical outcomes of Nissen fundoplication for symptomatic reflux between patients with normal and abnormal preoperative pH testing.

METHODS: Patients were selected from a prospective database of patients who underwent laparoscopic esophageal procedures between January 1997 and December 2001 at our institution.

Only patients having typical symptoms of GERD (heartburn and/or reflux), preoperative pH testing, manometry, and endoscopy and who had at least 6 months of post-operative follow-up were included in the study.

Fifteen patients had normal preoperative DeMeester scores (DMS) (median 11.4, range 3.3 to 14.7).

These were compared with 208 consecutive patients having abnormal preoperative DMS (median 49.6, range 15.2 to 250).

Logistic regression modeling was performed to identify variables significant for poor outcome.

Differences between means were tested using appropriate parametric or nonparametric tests.

RESULTS: There were no statistically significant differences in demographics, preoperative symptom score (mean 2.9 +/- 1.1 vs. 3.1 +/- 0.68, P = 0.30), or preoperative grade of esophagitis (P = 0.37) between the 2 groups.

After a median follow-up of 8.8 months (range 6 to 36), 6 (40%) of the patients having normal preoperative DMS and 17 (8.1%) of the patients having abnormal preoperative DMS continued to have typical GERD symptoms (P <0.01, B error = 0.02).

The most significant factor for poor outcome in the regression model was normal preoperative pH (odds ratio 9.02, P <0.01).

CONCLUSIONS: Symptomatic GERD patients with normal preoperative 24-hour pH test results have significantly worse subjective outcomes after Nissen fundoplication compared with patients having abnormal preoperative pH test results.

To minimize poor symptomatic outcomes after antireflux surgery, a policy of routine preoperative pH testing is advised.

PMID: 15135673 [PubMed - indexed for MEDLINE]

Am J Surg. 2004 May;187(5):599-603.
Outcomes of antireflux surgery in patients with normal preoperative 24-hour pH test results.
Khajanchee YS, Hong D, Hansen PD, Swanstrom LL.
Department of Minimally Invasive Surgery, Legacy Health System, 1040 N.W. 22nd St., Suite 560, Portland, OR 97210, USA.


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