Journal of Minimal Access Surgery Medknow Publications ISSN: 0972-9941 EISSN: 1998-3921 Vol. 7, Num. 2, 2011, pp. 161-162

Journal of Minimal Access Surgery, Vol. 7, No. 2, April-June, 2011, pp. 161-162

Letter to Editor

Authors' reply

Anish P Nagpal, Harshad Soni, Sanjiv Haribhakti

Department of Surgical Gastroenterology, Haribhakti Surgical Hospital, Ahmedabad, India

Correspondence Address: Anish P Nagpal, Haribhakti Surgical Hospital, 508, Sangita Complex, Opp. Doctor House, Near Parimal Crossing, Ahmedabad - 380 006, Gujarat, India, dranagpal@gmail.com

Code Number: ma11037

Dear Sir,

We appreciate your keen interest in our article ^[1] and your comments ^[2] are well taken. There is no doubt that 24-hour ambulatory pH metry and manometry are helpful before Laparoscopic Antireflux surgery, and in the western literature, they are considered to be the gold standard before surgery for selection of a particular procedure, either a total or a partial fundoplication. Few patients with abnormal oesophageal peristalsis will certainly not do well after a complete 360 degree Fundoplication. However, pH metry and manometry are not widely available even in major cities, in developing countries like India. We did this retrospective study to look at our single surgeon experience of Laparoscopic Antireflux Surgery, done without pH metry and manometry. We routinely perform the complete 360 degree Floppy Nissen′s Fundoplication procedure for all patients undergoing antireflux surgery. In our study of 46 patients, only one patient (2.18%) required conversion from 360 degree Fundoplication to Partial Toupet Fundoplication. Certainly this patient would have benefitted if all the 46 patients would have had a preoperative pH metry and manometry. However, in our experience 98% of the patients have a satisfactory outcome with the 360 degree Fundoplication done without pH metry and manometry. These results match with the results of other studies, ^[3] suggesting a similar outcome after a routine preoperative pH metry and manometry.

References

1.	Nagpal AP, Soni H, Haribhakti S. Is oesophageal manometry a must before laparoscopic fundoplication? Analysis of 46 consecutive patients treated without preoperative manometry. J Min Access Surg 2010;6:66-9.  Back to cited text no. 1  [PUBMED]
2.	Yagnik VD. Is oesophageal manometry a must before laparoscopic fundoplication? J Min Access Surg 2011; 161.  Back to cited text no. 2
3.	Huttl TP, Hohle M, Wichmann MW, Jauch KW, Meyer G. Techniques and results of laparoscopic antireflux surgery in Germany. Surg Endosc 2005;19:1579-87.  Back to cited text no. 3

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