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Background: Improvement in lower esophageal sphincter (LES) competency after laparoscopic Nissen fundoplication (LNF) is well established, yet esophageal body physiology data are limited. We aimed to describe the impact of LNF on whole esophagus physiology using standard and novel manometric characteristics. Methods: A cohort of patients with an intact fundoplication without herniation and no postoperative dysphagia were selected and underwent esophageal manometry at one‐year after surgery. Pre‐ and post‐operative manometry files were reanalyzed using standard and novel manometric characteristics and compared. Key Results: A total of 95 patients were included in this study. At 16.1 (8.7) months LNF increased LES overall and abdominal length and resting pressure (p < 0.0001). Outflow resistance (IRP) increased [5.8 (3–11) to 11.1 (9–15), p < 0.0001] with a 95th percentile of 20 mmHg in this cohort of dysphagia‐free patients. Distal contractile integral (DCI) also increased [1177.0 (667–2139) to 1321.1 (783–2895), p = 0.002], yet contractile amplitude was unchanged (p = 0.158). There were direct correlations between pre‐ and post‐operative DCI [R: 0.727 (0.62–0.81), p < 0.0001] and postoperative DCI and postoperative IRP [R: 0.347 (0.16–0.51), p = 0.0006]. Contractile front velocity [3.5 (3–4) to 3.2 (3–4), p = 0.0013] was slower, while distal latency [6.7 (6–8) to 7.4 (7–9), p < 0.0001], the interval from swallow onset to proximal smooth muscle initiation [4.0 (4–5) to 4.4 (4–5), p = 0.0002], and the interval from swallow onset to point when the peristaltic wave meets the LES [9.4 (8–10) to 10.3 (9–12), p < 0.0001] were longer. Esophageal length [21.9 (19–24) to 23.2 (21–25), p < 0.0001] and transition zone (TZ) length [2.2 (1–3) to 2.5 (1–4), p = 0.004] were longer. Bolus clearance was inversely correlated with TZ length (p = 0.0002) and time from swallow onset to proximal smooth muscle initiation (p < 0.0001). Bolus clearance and UES characteristics were unchanged (p > 0.05). Conclusions & Inferences: Increased outflow resistance after LNF required an increased DCI. However, this increased contractile vigor was achieved through sustained, not stronger, peristaltic contractions. Increased esophageal length was associated with increased TZ and delayed initiation of smooth muscle contractions. [ABSTRACT FROM AUTHOR]

Background: The most recent update of the Chicago Classification (CCv4.0) attempts to provide a more clinically relevant definition for ineffective esophageal motility (IEM). The impact of this new definition on predicting outcome after antireflux surgery is unknown. The aim of this study was to compare utility of IEM diagnosis based on CCv4.0 to CCv3.0 in predicting surgical outcome after magnetic sphincter augmentation (MSA) and to assess any additional parameters that hold value in future definitions. Methods: Records of 336 patients who underwent MSA at our institution between 2013 and 2020 were reviewed. Preoperative manometry files were re‐analyzed using both Chicago Classification version 3.0 (CCv3.0) and CCv4.0 definitions of IEM. The utility of each IEM definition in predicting surgical outcome was then compared. Individual manometric components and impedance data were also assessed. Key Results: Immediate dysphagia was reported by 186 (55.4%) and persistent dysphagia by 42 (12.5%) patients. CCv3.0 IEM criteria were met by 37 (11%) and CCv4.0 IEM by 18 (5.4%) patients (p = 0.011). CCv3.0 and CCv4.0 IEM were equally poor predictors of immediate (AUC = 0.503 vs. 0.512, p = 0.7482) and persistent (AUC = 0.519 vs. 0.510, p = 0.7544) dysphagia. The predicted dysphagia probability of less than 70% bolus clearance (BC) was 17.4%, higher than CCv4.0 IEM at 16.7%. When BC was incorporated into CCv4.0 IEM criteria, the probability increased significantly to 30.0% (p = 0.0042). Conclusions & Inferences: The CCv3.0 and CCv4.0 of IEM are poor predictors of dysphagia after MSA. Adding BC to the new definition improves its predictive utility and should be considered in future definitions. [ABSTRACT FROM AUTHOR]