LAUSR

BACKGROUND Currently, the reported parameters that predict the resolution of symptoms after surgery are largely subjective and unreliable. Considering that fundoplication rebuilds the structural integrity of the lower esophageal sphincter (LES), we focused on searching for objective and quantitative predictors for the resolution of symptoms based on the anatomical issues and whether an anti-reflux barrier can be well established or not. MATERIAL AND METHODS We reviewed the prospectively collected data of 266 patients with GERD who had undergone laparoscopic Nissen fundoplication (LNF). All patients were diagnosed with GERD using preoperative esophagogastroduodenoscopy, 24-hour ambulatory esophageal pH monitoring, and high-resolution esophageal manometry. The patients received GERD symptom surveys using the validated Korean Anti-Reflux Surgery group questionnaire twice: preoperatively and three months after the surgery. RESULTS After excluding patients with insufficient follow-up data, 152 patients were included in the analysis. Multivariate logistic regression analyses revealed that a longer length of the lower esophageal sphincter (LES) and lower body mass index (BMI) determined better resolution of typical symptoms after LNF (all P<0.05). Regarding atypical symptoms, higher resting pressure of LES and DeMeester score ≥14.7 were associated with better resolution after the surgery (all P<0.05). After LNF, typical symptoms improved in 34 out of 37 patients (91.9%) with a length of LES >4.05 cm, BMI <23.67 kg/m2, and atypical symptoms were resolved in 16 out of 19 patients (84.2%) with resting pressure of LES ≥19.65 mmHg, DeMeester score ≥14.7. CONCLUSION These results show that the preoperative length and resting pressure of LES is important in the objective prediction of symptom improvement after LNF.