The preoperative evaluation of patients considered for laparoscopic antireflux surgery.

作者：Waring Jp, Hunter Jg, Margrét Oddsdóttir, Wo J, E Katz · 发表于：PubMed · 年份：1995 · 被引用次数：127 · 研究领域：Gastroesophageal reflux and treatments、Esophageal and GI Pathology、Cardiac, Anesthesia and Surgical Outcomes

Few studies address the proper extent of the preoperative testing in patients referred for consideration of antireflux surgery. Our aim was to perform a thorough gastroesophageal evaluation and determine its influence on the therapeutic decisions of such patients. We evaluated 107 consecutive patients in a combined GI/Surgery clinic for severe or refractory gastroesophageal reflux. The patients had an EGD, esophageal manometry, and 24-h ambulatory esophageal pH monitoring. Only patients with gastric symptoms had gastric testing. Nineteen patients were excluded, 12 refused further evaluation and seven were felt to be unfit for antireflux surgery because of medical or psychological reasons. Eighty-eight patients completed the required studies. Fifty-four patients (61%) had typical reflux symptoms and erosive esophagitis on EGD. All these patients had an abnormal pH study. Five of the 34 patients without esophagitis had a normal pH study and did not have surgery. Ten patients had poor peristalsis by esophageal manometry prompting a subtotal fundoplication. One patient had severe delayed gastric emptying, requiring pyloroplasty in addition to the fundoplication. Eighty of 83 patients had good or excellent surgical results. EGD and esophageal manometry are indispensable in the preoperative evaluation. Manometry may identify abnormalities altering surgical decisions in roughly 10% of patients. Routine ambulatory esophageal pH monitoring is of marginal benefit, except in patients wi...