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Ann Thorac Surg 1994;58:66-73
© 1994 The Society of Thoracic Surgeons

Articles

Antireflux operations in patients with scleroderma

Nancy Claire Poirier, MD, Raymond Taillefer, MD, Philippe Topart, MD, André Duranceau, MD*

Division of Thoracic Surgery, Department of Surgery, Université de Montréal, Hôtel-Dieu de Montréal, Montréal, Québec, Canada

* Address reprint requests to Dr Duranceau, Department of Surgery, Hôtel-Dieu de Montréal, 3840, St-Urbain, Montréal, Québec Canada H2W 1T8.

Fourteen patients with sclerodenna underwent antireflux operations (10 snort Nissen, 2 Collis-Nissen, 1 Collis-Belsey, and 1 vagotomy and antrectomy with Roux-en-Y). Esophageal function was assessed preoperatively and postoperatively with a follow-up range of 8 to 181 months (mean, 65 months). Reflux symptoms were relieved in 10 of the 14 patients (p < 0.01), as shown by a decrease in their 24-hour acid exposure of from 15% to 7.5% (p < 0.05). However, the lower esophageal sphincter pressure gradient created by the operations did not increase significantly (3.7 ± 3.4 mm Hg to 5.5 ± 3.5 mm Hg). The esophageal acid exposure decreased sufficiently to promote some alleviation of the esophagitis. Radiologie signs of stenosis regressed in 6 of 7 patients. Postoperative endoscopie assessment revealed complete or partial healing of erosions seen preoperatively in 6 of the 7 patients so studied, and healing of all ulcers in 3 patients. Twelve patients continued to have columnar metaplasia. Manometric studies disclosed no significant changes in propulsion and contractility. Distal esophageal resting pressures rose significantly from 6.2 to 9.4 mm Hg (p < 0.05 mm Hg), suggestive of stasis. Radionuclide transit studies, however, showed no significant decrease in the esophageal emptying capacity after operation. It is concluded that conventional antireflux operations in patients with scleroderma can palliate reflux damage without jeopardizing esophageal function.




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 Ann. Thorac. Surg.Home page
M. S. Kent, J. D. Luketich, K. Irshad, O. Awais, M. Alvelo-Rivera, P. Churilla, H. C. Fernando, and R. J. Landreneau
Comparison of Surgical Approaches to Recalcitrant Gastroesophageal Reflux Disease in the Patient with Scleroderma
Ann. Thorac. Surg., November 1, 2007; 84(5): 1710 - 1716.
[Abstract] [Full Text] [PDF]


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