Supplementary Material for: Effect of Laparoscopic Antireflux Surgery on Esophageal Motility

<b><i>Background/Aims:</i></b> The effect of laparoscopic antireflux surgery on esophageal motility is incompletely understood, and any indication for this procedure in patients with motility disorder is disputed in literature. We evaluated the influence of laparoscopic Nissen fundoplication on impaired esophageal motility. <b><i>Methods:</i></b> In this pathological manometric study, we divided the patients into two groups preoperatively: the hypomotility group (mean amplitude of esophageal contraction wave &lt;40 mm Hg; HYPO group, n = 11) and the normal group (mean amplitude of esophageal contraction wave &gt;40 mm Hg; NORM group, n = 43). The amplitudes of esophageal contraction waves 3 and 8 cm above the lower esophageal sphincter and the percentage of peristaltic contraction waves of the tubular esophagus were analyzed pre- and postoperatively. <b><i>Results:</i></b> In total, 54 patients with GERD underwent esophageal manometry before and 6 months after Nissen fundoplication. The length and pressure of the lower esophageal sphincter were increased in both groups postoperatively (p &lt; 0.01). Patients in the HYPO group (n = 11) showed a statistically significant increase of mean amplitude of esophageal contraction (32.8 vs. 57.3 mm Hg; p &lt; 0.01), while no change was found in the NORM group (n = 43). A total of 72% of patients with preoperative motility disorder showed normal postoperative manometry. <b><i>Conclusion:</i></b> Nissen fundoplication normalizes esophageal motility, especially in patients with preoperative hypomotility. Patients with impaired esophageal motility should not per se be excluded from antireflux surgery.

**背景与目的**：腹腔镜抗反流手术（laparoscopic antireflux surgery）对食管动力（esophageal motility）的影响尚未完全阐明，而针对合并食管动力障碍的患者实施该术式的适应证，目前学界仍存在诸多争议。本研究旨在评估腹腔镜尼森胃底折叠术（laparoscopic Nissen fundoplication）对食管动力受损患者的影响。**方法**：本项病理测压研究中，我们于术前将入组患者分为两组：动力低下组（食管收缩波平均振幅＜40 mmHg；HYPO组，n=11）与正常对照组（食管收缩波平均振幅＞40 mmHg；NORM组，n=43）。我们分别对术前与术后的食管下括约肌（lower esophageal sphincter, LES）上方3 cm、8 cm处的食管收缩波振幅，以及管状食管蠕动收缩波所占百分比进行了分析。**结果**：本研究共纳入54例胃食管反流病（gastroesophageal reflux disease, GERD）患者，所有患者均在尼森胃底折叠术前及术后6个月接受了食管测压（esophageal manometry）。术后两组患者的食管下括约肌长度与压力均较术前显著升高（p＜0.01）。动力低下组（n=11）患者的食管收缩波平均振幅较术前明显提升（32.8 vs. 57.3 mmHg；p＜0.01），而正常对照组（n=43）未观察到显著变化。术前合并食管动力障碍的患者中，共有72%在术后食管测压结果恢复正常。**结论**：尼森胃底折叠术可使食管动力恢复至正常水平，尤其对术前存在食管动力低下的患者效果更为显著。合并食管动力受损的患者不应被单纯排除在抗反流手术的适应证之外。