Faculty Collaboration Database

Postoperative dysphagia is not predictive of long-term failure after laparoscopic antireflux surgery. Surg Endosc 2012 Feb;26(2):451-7

Date

09/13/2011

Pubmed ID

21909851

DOI

10.1007/s00464-011-1898-4

Scopus ID

2-s2.0-84857043057 (requires institutional sign-in at Scopus site)   17 Citations

Abstract

INTRODUCTION: Dysphagia is a common postoperative symptom after laparoscopic antireflux surgery, usually attributed to postoperative edema or a "too tight" fundoplication. Although it is usually self-limited, it occasionally requires endoscopic dilation and rarely revisionary surgery. It has not been previously described whether postoperative dysphagia is associated with poorer long-term reflux control after fundoplication.

METHODS: We hypothesized that the presence of dysphagia in the early postoperative period is associated with long-term failure of the antireflux procedure and recurrence of gastroesophageal reflux disease (GERD) symptoms. A retrospective review of a prospectively maintained database of patients undergoing antireflux surgery was performed. The study population included patients, who underwent primary laparoscopic Nissen fundoplication between the years 1991 and 2010. The presence of dysphagia on their first postoperative visit (<30 days) was used to classify them in the early-dysphagia (ED) and the no-early-dysphagia (NED) groups. The recurrence of heartburn or regurgitation, as well as the pH studies on long-term follow-up (more than 6 months) were compared between the two groups. A grading system (range 0-4) was used to measure the severity of foregut symptoms.

RESULTS: 1223 patients underwent primary laparoscopic Nissen fundoplications during the study period and met the inclusion criteria. Both short and long-term follow-up was available in 821 patients, who were analyzed. 423 patients were included in the ED group, whereas 398 in the NED group. The mean regurgitation score of the ED group on the long-term follow-up was 0.25 compared to 0.20 for the NED group (P = 0.21). The heartburn score was 0.38 for the ED group compared to 0.33 for the NED group (P = 0.38). Long-term dysphagia was higher in the ED group. These findings were confirmed when ED patients were subclassified based on the degree of early post-operative dysphagia. Of the 821 patients, 599 underwent routine postoperative pH testing. The mean DeMeester score in the ED group (n = 308) was 11.7 compared to 13.2 for the NED group (n = 291; P = 0.54). The percentage of patients with abnormal pH testing was similar between the two groups.

CONCLUSIONS: Early postoperative dysphagia is not associated with worse long-term GERD symptom control after primary laparoscopic antireflux surgery.

Author List

Makris KI, Cassera MA, Kastenmeier AS, Dunst CM, Swanström LL

Author

Andrew Sean Kastenmeier MD Associate Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Aged, 80 and over
Deglutition Disorders
Female
Fundoplication
Gastroesophageal Reflux
Heartburn
Humans
Hydrogen-Ion Concentration
Laparoscopy
Long-Term Care
Male
Middle Aged
Prospective Studies
Retrospective Studies
Treatment Failure
Young Adult