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J Gastrointest Surg. 2011 Sep;15(9):1506-12. doi: 10.1007/s11605-011-1597-4. Epub 2011 Jun 30.

Postoperative impedance-pH testing is unreliable after Nissen fundoplication with or without giant hiatal hernia repair.

Author information

1
Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, OR 97210, USA.

Abstract

INTRODUCTION:

Combined 24-h multichannel intralumenal impedance-pH monitoring (MII-pH) is gaining popularity as a diagnostic tool for gastroesophageal reflux. Since the surgical reduction of hiatal hernias and creation of a fundoplication anatomically restores the gastroesophageal reflux barrier, one would assume that it effectively stops all reflux regardless of composition. Our aim is to evaluate the results of routine MII-pH testing in successful Nissen fundoplication patients.

MATERIAL AND METHODS:

Sixty-two patients with normal acid exposure, confirmed by 24-h pH testing, after Nissen fundoplication were evaluated with symptomatic questionnaire, esophageal manometry and MII-pH testing more than 6 months after surgery. Patients were grouped into normal and abnormal based on postoperative impedance results. Patients with Nissen alone were separately compared to patients with Nissen + giant hiatal hernia (GHH).

RESULTS:

Twenty-nine (47%) patients exhibited abnormal impedance after successful Nissen fundoplication. Abnormal impedance was associated with GHH repair, lower bolus pressures, and lower distal esophageal contraction amplitudes.

CONCLUSION:

Postoperative testing with the standard MII-pH catheters using published normative values seems to be clinically irrelevant. Clinicians should analyze the results of routine MII-pH testing in the setting of a fundoplication critically as the current technology is associated with a high false positive rate.

PMID:
21717283
DOI:
10.1007/s11605-011-1597-4
[Indexed for MEDLINE]

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