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Ann Thorac Surg 1980;30:13-18
© 1980 The Society of Thoracic Surgeons

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Articles

Intraoperative Esophageal Manometry: Is It Valid?

From the Department of Surgery, Section of Thoracic Surgery, and the Department of Biostatistics, University of Michigan, Ann Arbor, MI

^* Address reprint requests to Dr. Orringer, C7079, Box 32, University Hospital, Ann Arbor, MI 48109

Forty-five patients undergoing a Collis-Nissen antireflux operation had preoperative, several intraoperative, and postoperative distal esophageal high-pressure-zone (HPZ) measurements. In 11 patients (24%), intraoperative manipulation of the esophagus alone, prior to beginning the repair, had a major effect upon the HPZ. The final mean intraoperative HPZ pressure (21.2 mm Hg) differed significantly (p < 0.01) from that obtained postoperatively at 1 to 3 weeks (15.2 mm Hg), 6 months (11.2 mm Hg), and 12 months (12.1 mm Hg). However, there was no significant statistical correlation between the final intraoperative HPZ pressures and those obtained after 6 and 12 months. Irrespective of the final intraoperative HPZ value, no patient undergoing acid reflux testing at 6 to 12 months after operation had any gastroesophageal reflux. It is concluded that esophageal manipulation (mobilization or dilation) results in variable intraoperative HPZ values that are not reliable predictors of HPZ values obtained late postoperatively. The rationale for altering the technique of an operation simply to obtain an "ideal" intraoperative HPZ value must be seriously questioned.

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