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BACKGROUND: Studies show higher rates of dissatisfaction with antireflux surgery (ARS) outcomes in patients with chronic constipation. This suggests a relationship between colonic dysmotility and suboptimal surgical outcome. However, due to limitations in technology, there is no objective data available examining this relationship. The wireless motility capsule (WMC) is a novel technology consisting of an ingestible capsule equipped with pH, temperature, and pressure sensors, which provide information regarding regional and whole gut transit times, pH and motility. The aim of this study was to assess the impact of objective regional and whole gut motility data on the outcomes of ARS. STUDY DESIGN: This was a retrospective review of patients who underwent WMC testing before ARS. Transit times, motility, and pH data obtained from different gastrointestinal tract regions were used in analysis to determine factors that impact surgical outcome. A favorable outcome was defined as complete resolution of the predominant reflux symptom and freedom from antisecretory medications. RESULTS: The final study population consisted of 48 patients (fundoplication [n = 29] and magnetic sphincter augmentation [n = 19]). Of those patients, 87.5% were females and the mean age ± SD was 51.8 ± 14.5 years. At follow-up (mean ± SD, 16.8 ± 13.2 months), 87.5% of all patients achieved favorable outcomes. Patients with unfavorable outcomes had longer mean whole gut transit times (92.0 hours vs 55.7 hours; p = 0.024) and colonic transit times (78.6 hours vs 47.3 hours; p = 0.028), higher mean peak colonic pH (8.8 vs 8.15; p = 0.009), and higher mean antral motility indexes (310 vs 90.1; p = 0.050). CONCLUSIONs: This is the first study to demonstrate that objective colonic dysmotility leads to suboptimal outcomes after ARS. WMC testing can assist with preoperative risk assessment and counseling for patients seeking ARS. Patients with GERD frequently have lower abdominal complaints, but little is known about the impact of objective hindgut physiology on antireflux surgery outcomes. Using wireless motility capsule technology, we demonstrate that objective colonic dysmotility and elevated colonic pH predict suboptimal antireflux surgery outcomes. [ABSTRACT FROM AUTHOR]

Backgrounds: Chevalier Jackson (1865-1958) was a pioneering force in the medical world, whose extraordinary contributions to surgery and public health have left an indelible impact. He developed the endoscope and perfected the bronchoscope, and his mastery of these tools enabled him to transform the prognosis of foreign body aspiration from 98% mortality to 98% survival. He was also a passionate advocate of public health chairing the national committee on lye legislation, which culminated in the Caustic Poison Act, responsible for poison and antidote labels. Yet Jackson's accomplishments were not limited to these. The aim of this manuscript was to shed light on Chevalier Jackson's lesser-known contributions to surgical science and culture, and to celebrate and honor the life of this remarkable surgeon., Methods: Digital and physical historical records from the National Library of Medicine, Smithsonian Institution, Heinz History Center in Pittsburgh PA, and Sunrise Mill Museum, Montgomery County PA were reviewed for Chevalier Jackson's scientific, cultural, and social contributions to the field of surgery., Results: Among his lesser-known contributions, Chevalier Jackson was the first to describe erosive esophagitis. He developed the first standardized tracheotomy procedure, still in use today. He was ahead of his time in many ways, pioneering a multidisciplinary approach to medicine, advocating for patient-centered care, and advancing the inclusion of women in the medical profession., Conclusion: Chevalier Jackson's legacy extends far beyond the tools and techniques he invented. He was a champion of social justice, a protector of patients, and an inspiration to medical professionals across the globe., (© 2023. The Author(s).)