The manometric pattern of either
diffuse esophageal spasm (DES),
nutcracker esophagus (NE), or hypertensive lower esophageal sphincter (HLES) in the presence of
gastroesophageal reflux disease (
GERD) is considered a secondary finding and treatment should be directed toward
GERD. This study aims to evaluate the outcomes of laparoscopic Nissen
fundoplication (LNF) in patients with manometric patterns of
esophageal motility disorders. Patients with
GERD confirmed by pH monitoring and manometric pattern of DES (simultaneous contractions 20 to 90% of wet swallows), NE (increased mean distal amplitude greater than 180 mmHg), or HLES (lower esophageal sphincter pressure greater than 45 mmHg) who underwent LNF were studied. A group of 50 consecutive patients with normal esophageal motility who underwent LNF were used as control subjects. Groups were comparable to control subjects for age, gender, preoperative symptoms,
hiatal hernia, and
Barrett's esophagus, except for NE that had younger individuals and a lower rate of
hiatal hernia. Symptomatic outcome was similar when groups were compared with control subjects. Transient
dysphagia was present in the postoperative period in 33, 7, 0, and 20 per cent of the patients with HLES, DES, NE, and control subjects, respectively. LNF is an adequate treatment for patients with
GERD and manometric patterns of
esophageal motility disorders.