J Minim Invasive Surg 1998; 1(2): 94-103
Published online December 20, 1998
© The Korean Society of Endo-Laparoscopic & Robotic Surgery
김경식*, 김충배, 김병로, 최진섭, 이우정
관동대학교* 및 연세대학교 의과대학 외과학교실
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
It has been reported that dyspeptic symptoms in a minority of the patients who undergo cholecystectomy are persistent. Cholecystectomy may have a direct effect on the developmet of dyspeptic symptoms, predisposing the patient to increased duodenogastric reflux. Excessive reflux of noxious duodenal content into the stomach has been associated with chronic gastritis, gastric ulceration, and esophagitis. We examined 9 patients with gallstone disease who underwent laparoscopic cholecystectomy to determine the changes in the gastroesophageal reflux and the esophageal function. All the patients underwent looth standard esophageal manomery to study esophageal function and 24-hr esophageal pH monitroing to ascertain the gastroesophageal reflux the prior to at the time of, and 3 months after the laparoscopic cholecystectomy. The mean lower esophageal sphincter (LES) length, the abdominal esophageal sphincter length, and the resting pressure of LES were incerased from 3.1cm, 2.3cm 19.9mmHg to 3.2cm, 2.6cm, 22.9mmHg, with no statistical significance. The mean sphincter function index increased from 1484 to 1888 after the operation with no statistical significance. The mean ampulitude of contraction in the upper, the middle, and the lower portions of the esophageal body, but again increased from 44.4mmHg, 59.8mmHg, and 87.5mmHg to 56.7mmHg, 84.44mmHg, and 117.8mmHg, respectively, after the operation. The mean DeMeester acid reflux score decreased from 13.5 to 7.0 after the operation(p=0.343).
In this study, the laparoscopic cholecystectomy did not affect the lower esophageal sphincter function. However there was an increase in the amplitude and the duration of contractions in the esophageal body. Therefore, the heartburn that persists after a cholecystectomy may be an esophageal origin. We suggest that al patients with biliary symptoms, but without documented acute cholecystitis should undergo full upper gastrointestinal investigations with esophagogastroduodenoscopy and pH monitoring (especially dual channel gastric and esophageal pH moniotring) to differentiate the esophageal pathology from other origins.
Keywords Laparoscopic cholecystectomy, Lower esophageal sphincter, Gastroesophageal reflux, DeMeester score 24-hr esophagea pH monitoring
J Minim Invasive Surg 1998; 1(2): 94-103
Published online December 20, 1998
Copyright © The Korean Society of Endo-Laparoscopic & Robotic Surgery.
김경식*, 김충배, 김병로, 최진섭, 이우정
관동대학교* 및 연세대학교 의과대학 외과학교실
Kyung Sik Kim, M.D., Choong Bai Kim, M.D., Byong Ro KIm , M.D., Jin Sub Choi, M.D., Woo Jung Lee, M.D.
Departemnt of Surgery, Kwandong* University College of Medicine, Kangnung, & Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
It has been reported that dyspeptic symptoms in a minority of the patients who undergo cholecystectomy are persistent. Cholecystectomy may have a direct effect on the developmet of dyspeptic symptoms, predisposing the patient to increased duodenogastric reflux. Excessive reflux of noxious duodenal content into the stomach has been associated with chronic gastritis, gastric ulceration, and esophagitis. We examined 9 patients with gallstone disease who underwent laparoscopic cholecystectomy to determine the changes in the gastroesophageal reflux and the esophageal function. All the patients underwent looth standard esophageal manomery to study esophageal function and 24-hr esophageal pH monitroing to ascertain the gastroesophageal reflux the prior to at the time of, and 3 months after the laparoscopic cholecystectomy. The mean lower esophageal sphincter (LES) length, the abdominal esophageal sphincter length, and the resting pressure of LES were incerased from 3.1cm, 2.3cm 19.9mmHg to 3.2cm, 2.6cm, 22.9mmHg, with no statistical significance. The mean sphincter function index increased from 1484 to 1888 after the operation with no statistical significance. The mean ampulitude of contraction in the upper, the middle, and the lower portions of the esophageal body, but again increased from 44.4mmHg, 59.8mmHg, and 87.5mmHg to 56.7mmHg, 84.44mmHg, and 117.8mmHg, respectively, after the operation. The mean DeMeester acid reflux score decreased from 13.5 to 7.0 after the operation(p=0.343).
In this study, the laparoscopic cholecystectomy did not affect the lower esophageal sphincter function. However there was an increase in the amplitude and the duration of contractions in the esophageal body. Therefore, the heartburn that persists after a cholecystectomy may be an esophageal origin. We suggest that al patients with biliary symptoms, but without documented acute cholecystitis should undergo full upper gastrointestinal investigations with esophagogastroduodenoscopy and pH monitoring (especially dual channel gastric and esophageal pH moniotring) to differentiate the esophageal pathology from other origins.
Keywords: Laparoscopic cholecystectomy, Lower esophageal sphincter, Gastroesophageal reflux, DeMeester score 24-hr esophagea pH monitoring
Muad Gamil M Haidar, Nuha Ahmed H Sharaf, Suha Abdullah Saleh, Prashant Upadhyay
Journal of Minimally Invasive Surgery 2024; 27(3): 156-164Saikrishna Aitha, Prakash Kumar Sasmal, Pankaj Kumar, Rutuja Challawar, Medhavi Sinha
Journal of Minimally Invasive Surgery 2024; 27(1): 51-54Takeshi Ueda, Tetsuya Tanaka, Yuki Kirihataya, Chisato Hara, Atsushi Yoshimura
Journal of Minimally Invasive Surgery 2023; 26(4): 218-221