Laparoscopic Fundoplication for Gastroesophageal Reflux: Effects on Esophageal Motility Rita Slim, MD, Jacques Forichon, MD, Jean Boulez, MD, and Franc ¸ois Mion, MD Summary: Laparoscopic Nissen-Rossetti fundoplication is now recognized as a valid therapy for the treatment of gastroesophageal reflux disease. This retrospective study evaluates the effects of laparoscopic fundoplication on esophageal motility and cor- relates these effects to postsurgical symptoms. A total of 123 patients underwent laparoscopic fundoplication at our institution. Pre- and postoperative esophageal manometric data were analyzed with regard to the effect of surgery and postsurgical outcome. Postoperative lower esophageal sphincter pressure was significantly in- creased compared wtih preoperative values (1.7 ± 0.8 kPa vs 0.9 ± 0.7 kPa). Duration and amplitude of esophageal body contractions were not modified. The percentage of deglutition-induced complete peristaltic waves and the velocity of propagation were significantly decreased after surgery (P < 0.05). Postoperative symptoms were signifi- cantly correlated with postoperative lower esophageal sphincter pressure only. Lapa- roscopic fundoplication significantly increases lower esophageal sphincter pressure. It significantly decreases esophageal body peristaltic efficiency, a decrease that is most likely of minor clinical significance. Key Words: Laparoscopic fundoplication— Manometry—Esophageal function—Gastroesophageal reflux. Laparoscopic Nissen fundoplication is now recog- nized as an effective surgical treatment for gastroesopha- geal reflux disease (GERD) (1). The main effect of this surgical procedure is a significant increase in lower esophageal sphincter pressure (LESP) (2), associated with a reduction in the number of spontaneous transient relaxations of the lower esophageal sphincter. Conflict- ing results have been reported about the effects of fun- doplication on esophageal body motility. Some authors have stated that nonspecific esophageal motor disorders associated with GERD should lead to a modification of the antireflux valve (3–6). Others have found a signifi- cant improvement in motility disorder after fundoplica- tion and have used this finding to advocate the secondary nature of these nonspecific esophageal body motor dis- orders, induced by GERD and improved by surgical therapy (7–9). The aim of this retrospective study was to evaluate the effect of laparoscopic Nissen-Rossetti fundoplication on the motility of the esophageal body, by comparing pre- and postoperative esophageal manometric results in a large population of patients with GERD undergoing sur- gery in a single center. PATIENTS AND METHODS Between June 1993 and December 1997, 303 patients with well-documented symptomatic GERD underwent a laparoscopic Nissen-Rossetti fundoplication at our insti- tution. Patients were included in the study if they had undergone pre- and postoperative manometry in our de- partment. Postoperative manometry was systematically proposed to the patients during the early follow-up pe- riod (1–3 months after surgery). A total of 123 patients satisfied the criteria for inclusion in the study. There were 78 men and 45 women, with a median age of 46 years (range, 16–81 years). Received September 13, 1999; revision received February 3, 2000; accepted February 7, 2000. From the Fe ´de ´ration des Spe ´cialite ´s Digestives, Ho ˆpital E. Herriot, Lyon, France. Address correspondence and reprint requests to Franc ¸ois Mion, MD, Pavillon H Bis, Ho ˆpital E. Herriot, 69437 Lyon cedex 03, France. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques Vol. 10, No. 3, pp. 115–119 © 2000 Lippincott Williams & Wilkins, Inc., Philadelphia 115