J Gastric Cancer.  2015 Jun;15(2):127-131. 10.5230/jgc.2015.15.2.127.

Laparoscopic Partial Fundoplication in Case of Gastroesophageal Reflux Disease Patient with Absent Esophageal Motility

• Seo KW
• Park MI
• Yoon KY
• Park SJ
• Kim SE

• KMID: 2372360
• DOI: http://doi.org/10.5230/jgc.2015.15.2.127

Abstract

The surgical indications for the treatment of gastroesophageal reflux disease (GERD) in patients with esophageal motility disorders have been debated. We report a case of antireflux surgery performed in a patient with absent esophageal motility as categorized by the Chicago classification (2011). A 54-year-old man underwent laparoscopic Toupet fundoplication due to apparent GERD and desire to discontinue all medications. After surgery, his subjective symptoms improved. Furthermore, objective findings including manometry and 24-hour pH-metry also improved. In our experience, antireflux surgery can improve GERD symptoms patients, even with absent esophageal motility.

Keyword

Laparoscope; Fundoplication; Manometry

MeSH Terms

Classification
Esophageal Motility Disorders
Fundoplication*
Gastroesophageal Reflux*
Humans
Laparoscopes
Manometry
Middle Aged

Figure

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  Fig. 1 Preoperative barium swallow showing retention of contrast flow at the distal esophagus with esophageal dilatation.

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  Fig. 2 (A) Preoperative endoscopic findings reveal that the gastric cardia is not tightly surrounding a retroflexed endoscope. (B) Postoperative endoscopic findings reveal lack of hiatal relaxation in the retroflexion view.

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  Fig. 3 Manometry showing absent peristalsis of the distal esophagus.

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  Fig. 4 Intraoperative photograph of completion of the Toupet fundoplication (A) and schematic (B).

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  Fig. 5 pH metry conducted 24 hours postoperatively showing improved esophageal acidity during the resting period.

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