TU1.9 Oesophageal manometry and ambulatory pH monitoring prior to laparoscopic anti-reflux surgery – is it a necessity? An evaluation of a newly established anti-reflux surgery service at a district general hospital

Abstract

Abstract Background Laparoscopic fundoplication is an effective surgical option for patients with symptoms of reflux refractory to proton-pump inhibitor (PPI) use. Oesophageal manometry and ambulatory pH monitoring are typically advocated as part of the evaluation of gastro-oesophgeal reflux disease, when anti-reflux surgery is considered. However, the requirement for these as a mandatory procedure remains controversial, particularly in the context of large hiatus hernia or presence of endoscopic reflux oesophagitis. Methods A retrospective review of all cases performed since the inception of the anti-reflux service at a single-centre district general hospital was undertaken. All patients who underwent an elective laparoscopic anti-reflux operation were included. Data pertaining to preoperative symptoms, preoperative investigations and postoperative outcomes (resolution of symptoms and PPI cessation) was collected. Results Over the three-year period, 22 anti-reflux operations were performed, of which 17 were followed up. The mean length of follow-up was 9.5 months. Most patients (91%) had typical reflux symptoms with a large hiatus hernia or endoscopic reflux oesophagitis. Only 4 (18.2%) patients underwent oesophageal manometry and ambulatory pH monitoring—each of these had either a normal preoperative OGD or barium swallow, or atypical symptoms. Alleviation of symptoms was achieved in 14 (82.3%) patients; 9 (52.9%) of which achieved complete resolution. PPI cessation was achieved in 12 (70.1%) patients, comparable with current literature. Conclusion Anti-reflux surgery can safely be performed without routine oesophageal manometry and ambulatory pH monitoring in the context of typical symptoms, a large hiatal defect or evidence of endoscopic reflux oesophagitis, as exemplified in our newly established anti-reflux service.