Verification of the Effectiveness of Nissen Fundoplication Without Myotomy in the Treatment of Nutcracker Esophagus – a Study of 11 Patients.

BACKGROUND: Nutcracker esophagus (NE) is a primary motor disorder characterized by esophageal peristaltic contractions of high amplitude. There is a relationship between gastroesophageal reflux disease (GERD) and NE. However, in spite of this, there is no consensus regarding the use of surgery for these diseases.
AIM: To evaluate the treatment of nutcracker esophagus (NE) using laparoscopic anti-reflux surgery (LARS) without esophagomyotomy in NE patients.
METHOD: Between January 2000 and February 2007, 11 patients with NE were prospectively analyzed, and all were diagnosed as having GERD. All patients underwent laparoscopic Nissen fundoplication. The diagnosis of NE was confirmed using esophageal manometry associated with videofluoroscopy, when necessary. GERD diagnosis was confirmed primarily by way of upper endoscopy, and 24-h pH monitoring, in cases where endoscopic diagnosis of GERD was not confirmed. Of the 11 patients studied, seven were women, with a mean age of 49.3±13.7 years. Heartburn and/or regurgitation, along with other typical symptoms of GERD were found in eight patients. Dysphagia and chest pain were reported by nine and seven patients, respectively.
RESULTS: There were no conversions to open surgery and no deaths or major complications. Nine patients remain asymptomatic, one being oligosymptomatic and one symptomatic, albeit to a lesser degree. The mean clinical follow-up was 21.1 ±17.3 months. The amplitude of peristalsis in the distal esophagus significantly improved, decreasing from a mean of 236.0±37.1mmHg to 156.0±52.8mmHg (p

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Program Number: P250

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