Causes of long-term dysphagia after laparoscopic Nissen fundoplication.

Kazuyoshi Sato, Ziad T. Awad, Charles Filipi, Mohamed A. Selima, Judd E. Cummings, Steve J. Fenton, Ronald A. Hinder

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

BACKGROUND: Laparoscopic fundoplication has revolutionized the surgical treatment of gastroesophageal reflux disease. Despite improvements in the technique of fundoplication, persistent dysphagia remains a significant cause of postoperative morbidity. METHOD: Causes of persistent postoperative dysphagia were analyzed in a consecutive series of 167 patients after laparoscopic Nissen fundoplication. Short gastric vessel division and its effect on postoperative dysphagia were analyzed. RESULTS: Follow-up was possible in 139 patients (83%). The mean follow-up period was 27 +/- 21 months. Nine patients (6%) had persistent (moderate to severe) dysphagia, and 33 patients (24%) had mild dysphagia. The satisfaction score among patients with persistent dysphagia was significantly lower than that in patients with mild dysphagia (P <0.0002). On the other hand, the satisfaction rate among patients with mild dysphagia and those who are asymptomatic was similar. Manometry, performed in 7 of 9 persistent dysphagia patients revealed no difference in postoperative lower esophagus sphincter (LES) pressure and relaxation as compared with that in the control group (n = 52). Six of 9 patients with persistent dysphagia underwent a re-do antireflux procedure. Dysphagia as related to fundic mobilization (complete vs. partial) or bougie size (<58 Fr. vs. > or = 58 Fr.) revealed no difference in the dysphagia ratings. CONCLUSIONS: Laparoscopic short Nissen fundoplication with or without fundic mobilization achieved an acceptable long-term dysphagia rate. Careful patient selection, identification of the short esophagus, and accurate construction of the fundoplication can lead to a decrease in the incidence of persistent postoperative dysphagia.

Original languageEnglish
Pages (from-to)35-40
Number of pages6
JournalJournal of the Society of Laparoendoscopic Surgeons
Volume6
Issue number1
StatePublished - 2002

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Fundoplication
Deglutition Disorders
Gastroesophageal Reflux
Patient Selection
Esophagus
Stomach
Morbidity

Cite this

Sato, K., Awad, Z. T., Filipi, C., Selima, M. A., Cummings, J. E., Fenton, S. J., & Hinder, R. A. (2002). Causes of long-term dysphagia after laparoscopic Nissen fundoplication. Journal of the Society of Laparoendoscopic Surgeons, 6(1), 35-40.

Causes of long-term dysphagia after laparoscopic Nissen fundoplication. / Sato, Kazuyoshi; Awad, Ziad T.; Filipi, Charles; Selima, Mohamed A.; Cummings, Judd E.; Fenton, Steve J.; Hinder, Ronald A.

In: Journal of the Society of Laparoendoscopic Surgeons, Vol. 6, No. 1, 2002, p. 35-40.

Research output: Contribution to journalArticle

Sato, K, Awad, ZT, Filipi, C, Selima, MA, Cummings, JE, Fenton, SJ & Hinder, RA 2002, 'Causes of long-term dysphagia after laparoscopic Nissen fundoplication.', Journal of the Society of Laparoendoscopic Surgeons, vol. 6, no. 1, pp. 35-40.
Sato, Kazuyoshi ; Awad, Ziad T. ; Filipi, Charles ; Selima, Mohamed A. ; Cummings, Judd E. ; Fenton, Steve J. ; Hinder, Ronald A. / Causes of long-term dysphagia after laparoscopic Nissen fundoplication. In: Journal of the Society of Laparoendoscopic Surgeons. 2002 ; Vol. 6, No. 1. pp. 35-40.
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abstract = "BACKGROUND: Laparoscopic fundoplication has revolutionized the surgical treatment of gastroesophageal reflux disease. Despite improvements in the technique of fundoplication, persistent dysphagia remains a significant cause of postoperative morbidity. METHOD: Causes of persistent postoperative dysphagia were analyzed in a consecutive series of 167 patients after laparoscopic Nissen fundoplication. Short gastric vessel division and its effect on postoperative dysphagia were analyzed. RESULTS: Follow-up was possible in 139 patients (83{\%}). The mean follow-up period was 27 +/- 21 months. Nine patients (6{\%}) had persistent (moderate to severe) dysphagia, and 33 patients (24{\%}) had mild dysphagia. The satisfaction score among patients with persistent dysphagia was significantly lower than that in patients with mild dysphagia (P <0.0002). On the other hand, the satisfaction rate among patients with mild dysphagia and those who are asymptomatic was similar. Manometry, performed in 7 of 9 persistent dysphagia patients revealed no difference in postoperative lower esophagus sphincter (LES) pressure and relaxation as compared with that in the control group (n = 52). Six of 9 patients with persistent dysphagia underwent a re-do antireflux procedure. Dysphagia as related to fundic mobilization (complete vs. partial) or bougie size (<58 Fr. vs. > or = 58 Fr.) revealed no difference in the dysphagia ratings. CONCLUSIONS: Laparoscopic short Nissen fundoplication with or without fundic mobilization achieved an acceptable long-term dysphagia rate. Careful patient selection, identification of the short esophagus, and accurate construction of the fundoplication can lead to a decrease in the incidence of persistent postoperative dysphagia.",
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