Skip to main content
SpringerLink
Log in

Lower Esophageal Sphincter Efficacy Following Laparoscopic Antireflux Surgery with Hiatal Repair: Role of Fluoroscopy, High-Resolution Impedance Manometry and FLIP in Detecting Recurrence of GERD and Hiatal Hernia

  • Chapter
  • First Online:
Hiatal Hernia Surgery

  • 1047 Accesses

Abstract

Hiatus hernia is an important risk factor for the development of gastroesophageal reflux disease. Hiatus hernia promotes gastric acid access to the esophagus and impairs its clearance. Surgical repair for hiatus hernia has developed over the years and show good results but there is still a need for development of current techniques due to the anatomical and physiological complexity of the esophago-gastric junction in health and disease. This chapter provides an insight into the complex anatomy and physiology of the esophago-gastric junction including the lower esophageal sphincter under physiological and remodeled conditions as observed in herniation and during surgical repair like fundoplication. The chapter deals in particular with efficacy evaluation based on fluoroscopy, impedance manometry, and FLIP.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  1. Stylopoulos N, Rattner DW. The history of hiatal hernia surgery: from Bowditch to laparoscopy. Ann Surg. 2005;241:185–93.

    PubMed  PubMed Central  Google Scholar 

  2. Miller LS, Vegesna AK, Brasseur JG, et al. The esophagogastric junction. Ann N Y Acad Sci. 2011;1232:323–30.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Mittal RK, Balaban DH. The esophagogastric junction. N Engl J Med. 1997;336:924–32.

    Article  CAS  PubMed  Google Scholar 

  4. Zaninotto G, DeMeester TR, Schwizer W, Johansson KE, Cheng SC. The lower esophageal sphincter in health and disease. Am J Surg. 1988;155:104–11.

    Article  CAS  PubMed  Google Scholar 

  5. Banki F, Mason RJ, Hagen JA, Bremner CG, Streets CG, Peters JH, DeMeester TR. The crura and crura-sphincter pressure dynamics in patients with isolated upright and isolated supine reflux. Am Surg. 2001;67:1150–6.

    CAS  PubMed  Google Scholar 

  6. Bombeck CT, Dillard DH, Nyhus LM. Muscular anatomy of the gastroesophageal junction and role of phrenoesophageal ligament; autopsy study of sphincter mechanism. Ann Surg. 1966;164:643–54.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Liebermann-Meffert D, Allgower M, Schmid P, et al. Muscular equivalent of the lower esophageal sphincter. Gastroenterology. 1979;76:31–8.

    CAS  PubMed  Google Scholar 

  8. Stelzner F, Stelzner M. Manometry data support a novel concept of the lower esophageal sphincter system. Langenbecks Arch Surg. 2010;395:1083–91.

    Article  PubMed  Google Scholar 

  9. Pettersson GB, Bombeck CT, Nyhus LM. The lower esophageal sphincter: mechanisms of opening and closure. Surgery. 1980;88:307–14.

    CAS  PubMed  Google Scholar 

  10. Korn O, Csendes A, Burdiles P, et al. Anatomic dilatation of the cardia and competence of the lower esophageal sphincter: a clinical and experimental study. J Gastrointest Surg. 2000;4:398–406.

    Article  CAS  PubMed  Google Scholar 

  11. Curcic J, Roy S, Schwizer A, et al. Abnormal structure and function of the esophagogastric junction and proximal stomach in gastroesophageal reflux disease. Am J Gastroenterol. 2014;109:658–67.

    Article  PubMed  Google Scholar 

  12. DeMeester TR, Wernly JA, Bryant GH, et al. Clinical and in vitro analysis of determinants of gastroesophageal competence. A study of the principles of antireflux surgery. Am J Surg. 1979;137:39–46.

    Article  CAS  PubMed  Google Scholar 

  13. Friedland GW. Progress in radiology: historical review of the changing concepts of lower esophageal anatomy: 430 B.C.--1977. AJR Am J Roentgenol. 1978;131:373–8.

    Article  CAS  PubMed  Google Scholar 

  14. Vantrappen G, Texter EC Jr, Barborka CJ, et al. The closing mechanism at the gastroesophageal junction. Am J Med. 1960;28:564–77.

    Article  CAS  PubMed  Google Scholar 

  15. Odze RD. Unraveling the mystery of the gastroesophageal junction: a pathologist’s perspective. Am J Gastroenterol. 2005;100:1853–67.

    Article  PubMed  Google Scholar 

  16. Mittal RK, Fisher M, McCallum RW, et al. Human lower esophageal sphincter pressure response to increased intra-abdominal pressure. Am J Phys. 1990;258:G624–30.

    CAS  Google Scholar 

  17. Hill LD, Kozarek RA, Kraemer SJ, et al. The gastroesophageal flap valve: in vitro and in vivo observations. Gastrointest Endosc. 1996;44:541–7.

    Article  CAS  PubMed  Google Scholar 

  18. Hill LD, Kozarek RA. The gastroesophageal flap valve. J Clin Gastroenterol. 1999;28:194–7.

    Article  CAS  PubMed  Google Scholar 

  19. Takeuchi R, Kato K, Mizuno S, et al. Abnormal gastroesophageal flap valve is highly associated with endoscopic reflux esophagitis after helicobacter pylori eradication. Helicobacter. 2004;9:1–8.

    Article  PubMed  Google Scholar 

  20. Thor KB, Hill LD, Mercer DD, et al. Reappraisal of the flap valve mechanism in the gastroesophageal junction. A study of a new valvuloplasty procedure in cadavers. Acta Chir Scand. 1987;153:25–8.

    CAS  PubMed  Google Scholar 

  21. Paterson WG. The normal antireflux mechanism. Chest Surg Clin N Am. 2001;11:473–83.

    CAS  PubMed  Google Scholar 

  22. Brasseur JG, Ulerich R, Dai Q, Patel DK, Soliman AMS, Miller LS. Pharmacological dissection of the human gastrooesophageal segment into three sphincteric components. J Physiol. 2007;580:961–75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. van Herwaarden MA, Samsom M, Smout AJ. The role of hiatus hernia in gastro-oesophageal reflux disease. Eur J Gastroenterol Hepatol. 2004;16:831–5.

    Article  PubMed  Google Scholar 

  24. Bashashati M, Sarosiek I, McCallum RW. Epidemiology and mechanisms of gastroesophageal reflux disease in the elderly: a perspective. Ann N Y Acad Sci. 2016;1380:230–4.

    Article  PubMed  Google Scholar 

  25. Curci JA, Melman LM, Thompson RW, Soper NJ, Matthews BD. Elastic fiber depletion in the supporting ligaments of the gastroesophageal junction: a structural basis for the development of hiatal hernia. J Am Coll Surg. 2008;207:191–6.

    Article  PubMed  Google Scholar 

  26. Patti MG, Goldberg HI, Arcerito M, Bortolasi L, Tong J, Way LW. Hiatal hernia size affects lower esophageal sphincter function, esophageal acid exposure, and the degree of mucosal injury. Am J Surg. 1996;171:182–6.

    Article  CAS  PubMed  Google Scholar 

  27. Jones MP, Sloan SS, Jovanovic B, Kahrilas PJ. Impaired egress rather than increased access: an important independent predictor of erosive oesophagitis. Neurogastroenterol Motil. 2002;14:625–31.

    Article  CAS  PubMed  Google Scholar 

  28. Gregersen H, Christensen J. Clinical biomechanics. An Introduction. Sharjah: Bentham Science Publishers; 2016.

    Book  Google Scholar 

  29. Mason RJ, DeMeester TR, Lund RJ, Peters JH, Crookes P, Ritter M, Gadenstatter M, Hagen JA. Nissen fundoplication prevents shortening of the sphincter during gastric distention. Arch Surg. 1997;132:719–24.

    Article  CAS  PubMed  Google Scholar 

  30. Bonavina L, Siboni S, Saino GI, Cavadas D, Braghetto I, Csendes A, Korn O, Figueredo EJ, Swanstrom LL, Wassenaar E. Outcomes of esophageal surgery, especially of the lower esophageal sphincter. Ann N Y Acad Sci. 2013;1300:29–42.

    Article  PubMed  Google Scholar 

  31. Kahrilas PJ. Anatomy and physiology of the gastroesophageal junction. Gastroenterol Clin N Am. 1997;26(3):467–86.

    Article  CAS  Google Scholar 

  32. Dent J, Holloway RH, Toouli J, Dodds WJ. Mechanisms of lower oesophageal sphincter incompetence in patients with symptomatic gastrooesophageal reflux. Gut. 1998;29(8):1020–8.

    Article  Google Scholar 

  33. Patti MG. An evidence-based approach to the treatment of gastroesophageal reflux disease. JAMA Surg. 2016;151(1):73–8.

    Article  PubMed  Google Scholar 

  34. Liu J, Parashar VK, Mittal RK. Asymmetry of lower esophageal sphincter pressure: is it related to the muscle thickness or its shape? Am J Phys. 1997;272:G1509–17.

    CAS  Google Scholar 

  35. Dent J. A new technique for continuous sphincter pressure measurement. Gastroenterology. 1976;71(2):263–7.

    CAS  PubMed  Google Scholar 

  36. Miller L, Dai Q, Vegesna A, Korimilli A, Ulerich R, Schiffner B, et al. A missing sphincteric component of the gastro-oesophageal junction in patients with GORD. Neurogastroenterol Motil. 2009;21(8):813–e52.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Nissen R, Eine E, Einfat HE. Operation zur Beeinflussung der R defluxochitis Schweiz. Schweiz Med Wochenschr. 1956;86:590–2.

    CAS  PubMed  Google Scholar 

  38. Lundell L, Myers JC, Jamieson GG. The effect of antireflux operations on lower oesophageal sphincter tone and postprandial symptoms. Scand J Gastroenterol. 1993;28(8):725–31.

    Article  CAS  PubMed  Google Scholar 

  39. Ireland AC, Holloway RH, Toouli J, Dent J. Mechanisms underlying the antireflux action of fundoplication. Gut. 1993;34(3):303–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Condon RE, Kraus MA, Wollheim D. Cause of increase in “lower esophageal sphincter” pressure after fundoplication. J Surg Res. 1976;20(5):445–50.

    Article  CAS  PubMed  Google Scholar 

  41. Higgs RH, Castell DO, Farrell RL. Evaluation of the effect of fundoplication on the incompetent lower esophageal sphincter. Surg Gynecol Obstet. 1975;141(4):571–5.

    CAS  PubMed  Google Scholar 

  42. Dodds WJ, Dent J, Hogan WJ, Helm JF, Hauser R, Patel GK, et al. Mechanisms of gastroesophageal reflux in patients with reflux esophagitis. N Engl J Med. 2010;307(25):1547–52.

    Article  Google Scholar 

  43. Dent J, Dodds WJ, Friedman RH, Sekiguchi T, Hogan WJ, Arndorfer RC, et al. Mechanism of gastroesophageal reflux in recumbent asymptomatic human subjects. J Clin Invest. 1980;65(2):256–67.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Mittal RK, Holloway RH, Penagini R, Blackshaw LA. Transient lower esophageal sphincter relaxation. Gastroenterology. 1995;109(2):601–10.

    Article  CAS  PubMed  Google Scholar 

  45. Penagini R, Schoeman MN, Dent J, Tippett MD, Holloway RH. Motor events underlying gastro-oesophageal reflux in ambulant patients with reflux oesophagitis. Neurogastroenterol Motil. 1996;8(2):131–41.

    Article  CAS  PubMed  Google Scholar 

  46. Franzi SJ, Martin CJ, Cox MR, Dent J. Response of canine lower esophageal sphincter to gastric distension. Am J Phys. 1990;259:G380–5.

    CAS  Google Scholar 

  47. The SAGES Guidelines Committee, Stefanidis D, Hope WW, Kohn GP, Reardon PR, Richardson WS, et al. Guidelines for surgical treatment of gastroesophageal reflux disease. Surg Endosc. 2010;24(11):2647–69.

    Article  Google Scholar 

  48. O'Hanrahan T, Marples M, Bancewicz J. Recurrent reflux and wrap disruption after Nissen fundoplication: detection, incidence and timing. Br J Surg. 1990;77(5):545–7.

    Article  PubMed  Google Scholar 

  49. Furnée EJB, Draaisma WA, Broeders IAMJ, Gooszen HG. Surgical reintervention after failed antireflux surgery: a systematic review of the literature. J Gastrointest Surg. 2009;13(8):1539–49.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Hill LD, Ilves R, Stevenson JK, Pearson JM. Reoperation for disruption and recurrence after Nissen fundoplication. Arch Surg. 1979;114(4):542–8.

    Article  CAS  PubMed  Google Scholar 

  51. Raeside MC, Madigan D, Myers JC, Devitt PG, Jamieson GG, Thompson SK. Post-fundoplication contrast studies: is there room for improvement? Br J Radiol. 2012;85(1014):792–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Carbo AI, Kim RH, Gates T, D’Agostino HR. Imaging findings of successful and failed fundoplication. Radiographics. 2014;34(7):1873–84.

    Article  PubMed  Google Scholar 

  53. Jailwala J, Massey B, Staff D, Shaker R, Hogan W. Post-fundoplication symptoms: the role for endoscopic assessment of fundoplication integrity. Gastrointest Endosc. 2001;54(3):351–6.

    Article  CAS  PubMed  Google Scholar 

  54. Kahrilas PJ, Kim HC, Pandolfino JE. Approaches to the diagnosis and grading of hiatal hernia. Best Pract Res Clin Gastroenterol. 2008;22(4):601–16.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Klaus A, Raiser F, Swain JM, Hinder RA. Manometric components of the lower esophageal double hump. Dig Dis. 2000;18(3):172–7.

    Article  CAS  PubMed  Google Scholar 

  56. Savarino E, de Bortoli N, Bellini M, Galeazzi F, Ribolsi M, Salvador R, et al. Practice guidelines on the use of esophageal manometry - A GISMAD-SIGE-AIGO medical position statement. Dig Liver Dis. 2016;48(10):1124–35.

    Article  PubMed  Google Scholar 

  57. Jobe BA, Richter JE, Hoppo T, Peters JH, Bell R, Dengler WC, et al. Preoperative diagnostic workup before antireflux surgery: an evidence and experience-based consensus of the esophageal diagnostic advisory panel. J Am Coll Surg. 2013;217(4):586–97.

    Article  PubMed  Google Scholar 

  58. Herbella FA. Critical analysis of esophageal multichannel intraluminal impedance monitoring 20 years later. ISRN Gastroenterol. 2012;2012:903240.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Hyun JJ, Bak YT. Clinical significance of hiatal hernia. Gut Liver. 2011;5(3):267–77.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Boeckxstaens GE. Alterations confined to the gastro-oesophageal junction: the relationship between low LOSP, TLOSRs, hiatus hernia and acid pocket. Best Pract Res Clin Gastroenterol. 2010;24(6):821–9.

    Article  PubMed  Google Scholar 

  61. Kessing BF, Conchillo JM, Bredenoord AJ, Smout AJ, Masclee AA. The clinical relevance of transient lower oesophageal sphincter relaxations in gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2011;33(6):650–61.

    Article  CAS  PubMed  Google Scholar 

  62. Kahrilas PJ, Shi G, Manka M, Joehl RJ. Increased frequency of transient lower esophageal sphincter relaxation induced by gastric distention in reflux patients with hiatal hernia. Gastroenterology. 2000;118(4):688–95.

    Article  CAS  PubMed  Google Scholar 

  63. van Herwaarden MA, Samsom M, Smout AJ. Excess gastroesophageal reflux in patients with hiatus hernia is caused by mechanisms other than transient LES relaxations. Gastroenterology. 2000;119(6):1439–46.

    Article  PubMed  Google Scholar 

  64. DeHaan RK, Davila D, Frelich MJ, Gould JC. Esophagogastric junction distensibility is greater following Toupet compared to Nissen fundoplication. Surg Endosc. 2017;31(1):193–8.

    Article  PubMed  Google Scholar 

  65. Lottrup C, McMahon BP, Ejstrud P, Ostapiuk MA, Funch-Jensen P, Drewes AM. Esophagogastric junction distensibility in hiatus hernia. Dis Esophagus. 2016;29(5):463–71.

    Article  CAS  PubMed  Google Scholar 

  66. Tatarian T, Pucci MJ, Palazzo F. A modern approach to the surgical treatment of Gastroesophageal reflux disease. J Laparoendosc Adv Surg Tech A. 2016;26(3):174–9.

    Article  PubMed  Google Scholar 

  67. Gordon C, Kang JY, Neild PJ, Maxwell JD. The role of the hiatus hernia in gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2004;20(7):719–32.

    Article  CAS  PubMed  Google Scholar 

  68. Pandolfino JE, Shi G, Trueworthy B, Kahrilas PJ. Esophagogastric junction opening during relaxation distinguishes nonhernia reflux patients, hernia patients, and normal subjects. Gastroenterology. 2003;125(4):1018–24.

    Article  PubMed  Google Scholar 

  69. Kwiatek MA, Kahrilas PJ, Soper NJ, et al. Esophagogastric junction distensibility after fundoplication assessed with a novel functional luminal imaging probe. J Gastrointest Surg. 2010;14(2):268–76.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Yassi R, Cheng LK, Al-Ali S, et al. Three-dimensional high-resolution reconstruction of the human gastro-oesophageal junction. Clin Anat. 2010;23:287–96.

    CAS  PubMed  PubMed Central  Google Scholar 

  71. Gregersen H, Liao D, Brasseur JG. The Esophagiome: concept, status, and future perspectives. Ann N Y Acad Sci. 2016;1380(1):6–18.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Prince of Wales Hospital, 4/F, Clinical Science Building, Shatin, NT, Hong Kong

    Vivien Wong & Hans Gregersen

  2. Trinity Academic Gastroenterology Group, Trinity College, Dublin, Ireland

    Barry McMahon

Authors
  1. Vivien Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Barry McMahon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hans Gregersen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hans Gregersen .

Editor information

Editors and Affiliations

  1. Faculty of Health Sciences and Medicine, University of Southern Queensland Faculty of Health Sciences and Medicine, Toowoomba, Queensland, Australia

    Muhammed Ashraf Memon

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Cite this chapter

Wong, V., McMahon, B., Gregersen, H. (2018). Lower Esophageal Sphincter Efficacy Following Laparoscopic Antireflux Surgery with Hiatal Repair: Role of Fluoroscopy, High-Resolution Impedance Manometry and FLIP in Detecting Recurrence of GERD and Hiatal Hernia. In: Memon, M. (eds) Hiatal Hernia Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-64003-7_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-64003-7_10

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-64002-0

  • Online ISBN: 978-3-319-64003-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation