Manometry

Esophageal manometry evaluates the peristaltic mechanism of the esophageal body (amplitude and character of peristaltic waves) and the pressure, location, and relaxation of the lower esophageal sphincter (LES). In the past, the results of manometry were used by many surgeons to "tailor" the subsequent fundoplication. Specifically, patients with impaired peristalsis underwent a partial fundoplication, such as a Toupet procedure. We have shown that most patients with defective esophageal peristalsis respond well to a Nissen fundoplication and do not develop postoperative dysphagia.13 Therefore, we recommend this as the treatment of choice except for those with essentially an aperi-staltic esophagus.13 Others have confirmed our results and these recommendations are becoming accepted by more groups.14

Likewise, the finding of other motility disorders such as hypercontractile esophagus (distal esophageal amplitudes >180 mm Hg) and hypertensive LES (>45mmHg) in the setting of GERD should not dissuade the surgeon from performing an anti-reflux procedure if the patient's clinical presentation is of GERD (heartburn or regurgitation) and not of a primary motility disorder (dysphagia or chest pain).15

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