The signi®cance of pH and manometric testing after laparoscopic fundoplication Are postoperative physiologic tests necessary? M. J. Arca, 1 M. Gagner A. Garcia-Ruiz, 2 B. T. Heniford 1 1 Department of General Surgery The Cleveland Clinic Foundation Cleveland, OH, USA 2 Department of Laparoscopic Surgery Mt. Sinai Hospital Box 1103, 5th Floor, Suite 5A, 19 East 98th Street, New York, NY 10029, USA Received: 12 March 2000/Accepted: 15 December 2000/Online publication: 9 January 2002 Abstract. Laparoscopic antire¯ux surgery has become the standard operation for gastroesophageal re¯ux dis- ease GERD). This study examined the outcomes of laparoscopic antire¯ux surgery, hypothesizing that both subjective symptoms and objective pH would correlate with manometric parameters to re¯ect the absence of re¯ux after fundoplication. We evaluated 56 patients who underwent laparoscopic antire¯ux surgery. Preop- erative and postoperative symptoms were documented by chart reviews and con®rmed by telephone interviews with the patient. Preoperative pH probe and esophageal manometry studies were compared with postoperative studies performed 3 to 6 months after fundoplication. Subjective symptoms were correlated with objective measurements of acid re¯ux and lower esophageal sphincterpressureLESP).Thefollow-upperiodwas3to 29 months. Symptomatic improvement was seen in 91% of patients, and good to excellent improvement in pre- operative symptoms was cited. Postoperatively, there was signi®cant improvement in percentages of upright supine times when esophageal pH was less than 4 p < 0.001).TherewasanincreaseinLESPfromanaverageof 16.9 mmHg preoperatively to 22.7 mmHg post- operatively p < 0.001). There was no correlation be- tween postoperative LESP and symptoms or LESP and 24-h pH results. However, there was a predictive corre- lation between LESP and postoperative heartburn symptoms p < 0.001). These ®ndings imply that symp- tom follow-up evaluation is adequate in the asympto- maticpatientafterlaparoscopicfundoplication,andthat routine physiologic testing is not necessary. Key words: Esophageal manometry Ð Fundoplication Ð 24-Hour pH test Gastroesophageal re¯ux disease GERD) is relatively common, aecting approximately 40% of the popula- tion [18]. Although medical therapy has been eective in healing re¯ux-mediated GERD, up to 85% of pa- tients have symptom recurrence after withdrawal of H2-blockers or proton pump inhibitors [4, 10]. Sur- gical therapy is eective in eradicating re¯ux symp- toms permanently [18]. Since the early 1990s [3], laparoscopic fundoplication has been adopted quickly as the preferred procedure for medically refractory GERD. Like other minimally invasive procedures, its appeal lies in decreased pain, short convalescence, and cosmetic bene®ts. Laparoscopic surgeons have been carefully stringent regarding the preoperative indica- tions for this operation. The workup generally in- cludes esophagogastroduodenoscopy and esophageal manometry/motility studies. Some patients may also require 24-h pH monitoring and a upper gastrointes- tinal contrast study [18]. After the operation, most patients experience rapid and dramatic symptomatic relief [5, 6, 14]. Therefore, controversy exists about whether routine postoperative physiologic studies are necessary. This study aimed to determine the correlation be- tween postoperative symptoms of GERD and postop- erative physiologic studies. We hypothesized that subjective symptoms, objective pH, and manometric parameters would correlate to re¯ect restoration of a nonre¯uxing state. We hope to establish guidelines re- garding appropriate physiologic studies after laparo- scopic fundoplication. Surg Endosc 2002) 16: 395±400 DOI: 10.1007/s00464-001-0001-y Ó Springer-Verlag New York Inc. 2002 Correspondence to: M. Gagner