Effect Of Laparoscopic Anti-reflux Surgery On Esophageal Dynamics

Objective: To study High resolution manometric characteristics of gastroesophagealreflux disease. A prospective randomized clinical study of esophageal motor functionbefore and after the different laparoscopic anti-reflux surgery. To study effectiveness andfeasibility of Application of animal model of Laparoscopic anti-reflux surgical trainingMethod: Retrospective analysis of high resolution manometry data of gastroesophagealreflux disease diagnosed at minimally invasive surgery department of People’s hospital ofXinjiang Uygur Autonomous Region from august2012to july2014. Comparative studythe data based on gender, age, BMI classification, morphology of gastroesophagealjunction. A prospective randomized clinical study of laparoscopic anti-reflux surgery,analysis of high resolution manometry data before and3month after the operation.in81GERD patients those received laparoscopic Nissen, Dor, Toupet fundoplication byRandom selection. After general anesthesia, everyone of6pigs has received laparoscopichiatal Herniorrhaphy and Nissen、Toupet、Dor fundoplication in order. Intra-operativecomplications、surgical procedures、priorities、technical difficulties and the precautionswere recorded. Result：Comparison of different gender, resting pressure and residualpressure of LES are lower in male patients than female patients, LES relaxation ratehigher in patients than female patients, the difference was statistically significant(P<0.05). esophageal of body peristalsis associated parameters are not significantlydifferent between genders. Comparison between different age groups shows thatassociated parameters are no statistical differences between the groups (P>0.05).400patients Included in this study with gastroesophageal reflux disease, overweight and obesepatients accounted for62%. Compared with the normal, in patients with gastroesophagealreflux disease, the pressure at3cm,7cm,11cm above LES and average pressure is lowerthan normal. DCI significantly lower than normal. CFV is greater than normal. Averageduration of the Peristalsis wave is shorter than nomal.Analysis of each swallowing, thenormal peristalsis is accounting for66.1%, aperistalsis is accounting for16.7%, swallowswith small breaks is accounting for9.6%, swallows with large breaks is accounting for 6.5%, Rapid contractions with normal latency is accounting for1.1%. Analysis of eachpatient, the normal peristalsis is accounting for40.5%, Weak peristalsis with largeperistaltic defects is accounting for15.25%, Weak peristalsis with small peristaltic defectsis accounting for18%, Frequent failed peristalsis is accounting for21.25%, Absentperistalsis is accounting for3%, Rapid contractions with normal latency is accounting for2%. According to morphology of gastroesophageal junction, Type I is accounting for4.75%, Type II is accounting for44.25%Type IIIa is accounting for48%, IIIb isaccounting for3%.51%of GERD accompanied with Hiatal Hernia, completelyoverlapping rate of LES and diaphragm is accounting for4.75%.27patienst in each groupreceived laparoscopic Nissen, Dor and Toupet fundoplication separately by Randomselection in81GERD patients. Comparison of esophageal body motility characteristicsbefore and after the surgery is not significantly different. In Nissen fundoplication group,the length of the esophagus, LES and intra-abdominal LES are elongated the differencewas statistically significant (P<0.05). LES resting pressure parameters and LES relaxationparameters are increased after operation. LES relaxation rate is decreased, the differencewas statistically significant (P<0.05). Comparison of esophageal body motilitycharacteristics before and after the surgery is not significantly different. In Dorfundoplication group, intra-abdominal LES are elongated the difference was statisticallysignificant (P<0.05). LES resting pressure parameters and LES relaxation parameters areincreased after operation. Comparison of the length of the esophagus and LES, esophagealbody motility characteristics before and after the surgery is not significantly different. InToupet fundoplication group, the length of the esophagus, LES and intra-abdominal LESare elongated, the difference was statistically significant (P<0.05). LES resting pressureparameters and LES relaxation parameters are increased after operation. Comparison ofesophageal body motility characteristics before and after the surgery is not significantlydifferent. LES relaxation rate is decreased,.comparison of esophageal motor function afterfundoplication between three groups shows that, there are longer LES, intra-abdominalLES and the esophagus in post Nissen and Toupet fundoplication than Dor fundoplication,the difference was statistically significant (P<0.05).there are higher LES resting pressureand LES relaxation pressure in post Nissen and Toupet fundoplication than Dorfundoplication, the difference was statistically significant (P<0.05).but there are lowerrelaxation rate after Nissen and Toupet fundoplication than Dor fundoplication, thedifference is statistically significant (P<0.05). comparison of esophageal motor functionafter fundoplication between three groups is not significantly different. Totally18 surgeries were performed on6pigs, including6cases of Nissen fundoplication,6cases ofToupet fundoplication,6cases of Dor fundoplication，and all surgery completedsuccessfully. There are no serious complications came out, with the increased frequency oftraining, the operation time is significantly reduced. Conclusion: male inferior to femalein esophageal motor function, there is no difference of esophageal motility in gender andBMI classification. Compared to normal, LES pressure and motility function ofesophageal body are significantly lower in gastroesophageal reflux disease, Weakperistalsis with large and small peristaltic defects, frequent failed peristalsis are Morecommon. There is no effect of laparoscopic anti-reflux surgery on esophageal body motorfunction. But the LES pressures are increased and LES relaxation rate is decreased afterfundoplication. The variations are very distinct in Nissen fundoplication, Toupetfundoplication has modest effects and Dor fundoplication has the minimal effect in thegroup. Correspond to clinical practice, the Nissen fundoplication has a best anti-refluxeffect and highest postoperative dysphagia, Dor Fundoplication has a worst anti-refluxeffect and lowest postoperative dysphagia, when Toupet fundoplication has a mediumeffort. It is feasible, safe and effective to build the Laparoscopic anti-reflux surgerytraining model in pigs. Because of the operation on animal model is reversible andrepeatable, this can provide helpful training opportunities for surgeons, significantlyreduced the time of mastering on surgical technique.