A retrospective analysis of the efficiency of intraoperative high-resolution manometry was conducted to examine the life satisfaction of patients before and after surgery for reflux disease and a hiatal hernia
Authors: Saad Hassan A. , Baz Azza , Farid Mohamed I , Eraky Mohamed E , Riad Mohamed , El-Taher Ahmed K , Sharaf Khaled 
Published: October 2023

Abstract
Traditional manometry-based studies in the past revealed two separate pressure zones in HH patients at the EGJ level, indicating the patial separation of LES and CD; however,they were unable to attain optimal sensitivity. High-resolution manometry (HRM) can accurately determine the differences between CD and LES and evaluate their anatomical relationships. Three EGJ subtypes were described by HRM and determind using LES-CD distinction. However, few studies have been conducted too determine the precision of the diagnosis. The affected individuals' GERD-standard lifestyle is impaired by reflux complications. An operation is a possible option for the cure of illnesses, even though PPIs produce a significant improvement in the management of difficulties owing to the requirement for continued use of the drug and the reality that over three per cent of these individuals still experience problems despite proper use . The objectives of this study were to evaluate the outcomes and side effects of MIS therapy for GERD and asssess the satisfaction of existence associated with GERD before and after GERD and/or hiatus hernia surgery. In addition ,we assessed the diagnostic accuracy of high-resolution manometry in detecting hiatal hernia compared to esophagogram and esophagogastroduodenoscopy, using surgical in vivo measurement as a reference.
Methods: Computerized records of individuals with GERD who underwent surgery and/or individuals with sliding or paraesophageal hernias were analyzed in this retrospective study. Individuals who underwent laparoscopy at the Zagazig University Hospital between January 2016 and March 2023 participated in the study. This research was observational, longitudinal, descriptive, and included retrospective data analysis. Surgery was recommended because of poor response to medical therapy, young age, prolonged indicators, or GERD consequences. During surgery, there were 100 cases, and 53 (53%) patients had HHs. Forty-seven (47%) patients were classified as type I EGJ, 35 (35%) as type II, and 18 (18%) as type III EGJ, as examined by manometry (HRM) esophagogram, and EGD.
Results: From 2016 to 2023, 320 patients who underwent laparoscopic anti-reflux surgery were examined .The mean age of the 176 women and 144 men who underwent surgery was 46.6± 13.7 years. Before surgery, QS-GERD scores improved compared to post-surgery scores (27.56 10.93 vs. 1.4 2.47, p 0.01). Furthermore, it was discovered that none of the following factors sex, age, body mass index, surgical method, or the number of stitches on the fundoplication valve—were associated with a poorer outcome or failure probability. With a global median of 24 hours and a mean of 28.7 hours, the average hospitalisation was 24 hours for 74.2% of individuals, 48 hours for 19.3%, and 72 hours for 4.6%. There were no initial surgical problems (such as seroma, infections of the wounds, or eventration) or deaths, and no patients who needed blood transfusions were not required.
The effectiveness of intraoperative manometry was evaluated in all 100 patients. The kappa values for high-resolution manometry and in vivo evaluation were 0.85. High-resolution manometry showed optimal sensitivity and specificity in detecting type I, II, and III esophagogastric junctions compared to endoscopy and esophageal.
Conclusions:
summarise the body of knowledge that exists on this topic
1-Sliding HH presence has been linked to aberrant esophageal acid exposure, extended esophageal clearance, and a rise in reflux episodes. It is more frequently observed when the GERD becomes more severe.
2-Barium swallow esophagogram and EGD can both be used to diagnose HHs, although these two techniques are hampered by the subjective and oblique evaluation of EGJ components
3-In the treatment of GERD patients, a more accurate diagnostic assessment of HH presence and axial dislocation may be helpful.