ArticleNeurogastroenterology and motility2025
Validation of Padova Classification of Post-Fundoplication Outflow Obstruction on High-Resolution Manometry in an International Multi-Center Study.
Article in Neurogastroenterology and motility, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Diagnostic Accuracy of High-Resolution Manometry for Assessing Fundoplication Integrity: Validation of the Padova Classification.Neurogastroenterology and motility · 2026Article
- Integrating Impedance Planimetry With the Padova Classification: A Valuable Direction for Future Refinement.Neurogastroenterology and motility · 2026Article
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12 authors.
Funding
Abstract
backgroundDysphagia after laparoscopic Nissen fundoplication (LNF) is common and may be due to post-fundoplication outflow obstruction (PFOO) as defined by high-resolution manometry (HRM) using the Padova Classification. This study aimed to compare clinical and HRM parameters between patients with manometric PFOO and those with a functioning, effective fundoplication (FELF), and to evaluate treatment outcomes in PFOO patients.
methodsThis retrospective study from two international centers included patients who underwent LNF and postoperative HRM between January 2000 and January 2025. Patients were categorized into PFOO (manometric PFOO) and FELF (manometric FELF and normal reflux study) groups. HRM parameters including LES basal pressure, integrated relaxation pressure (IRP), and esophageal body function were compared. Postoperative dysphagia was assessed clinically, and treatment outcomes in PFOO patients were evaluated.
resultsAmong 106 patients (62 PFOO, 44 FELF), the PFOO group showed significantly higher median LES basal pressure (41.2 vs. 23.7 mmHg, p < 0.01), IRP (19.3 vs. 10.3 mmHg, p < 0.01), and LES lengths (p = 0.01). PFOO patients had an increased incidence of elevated intrabolus pressure and premature swallows (p < 0.01). Dysphagia was reported in 89% of PFOO patients versus 5% in FELF (p < 0.01). Of symptomatic PFOO patients undergoing retreatment (pneumatic dilation, redo surgery, or both), 89% achieved symptom improvement.
conclusionsThis first study applying the Padova Classification confirms HRM can distinguish obstructive from functional fundoplications post-LNF, supporting its diagnostic role in managing postoperative dysphagia.
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