title: Factors predictive of dysphagia after laparoscopic Nissen fundoplication.
abstract: BACKGROUND
  Persistent postoperative dysphagia occurs in up to 24% of patients who undergo a laparoscopic Nissen fundoplication for reflux disease [7]. We hypothesized that patient history, pH testing, and esophageal manometry could be used to preoperatively identify patients at risk for this complication.
  
  
  METHODS
  Of 156 laparoscopic Nissen fundoplications performed over a 27-month period, we identified 19 patients (12%) who suffered from postoperative dysphagia longer than 3 months. The presenting complaint of preoperative swallowing difficulty was noted as was the presence of a known esophageal stricture. Preoperative pH testing and esophageal manometry were performed for all subjects. We compared the following parameters to an age and gender-matched control group: history of esophageal stricture, presence of preoperative dysphagia, DeMeester reflux score, upper esophageal sphincter pressure and relaxation, esophageal body motility, location of respiratory inversion point, and lower esophageal sphincter length, resting pressure, and relaxation. Data were compared via t-test and Fisher's exact test.
  
  
  RESULTS
  Patients who presented before surgery with complaints of difficulty swallowing were more likely to suffer from postoperative dysphagia (p = 0.029). Incidence of stricture, DeMeester score, and manometric measurements did not differ between the dysphagia and control groups (p > 0.05 for all parameters).
  
  
  CONCLUSIONS
  Although preoperative studies are not helpful in identifying patients at risk for persistent dysphagia after laparoscopic Nissen fundoplication, patients presenting with the preoperative complaint of difficulty swallowing are at increased risk for this complication.
authors.affiliation: Legacy Division of Minimally Invasive Surgery, Legacy Emanuel Hospital, 501 North Graham, Suite 120, Portland, OR 97227, USA.
authors.forename: D M
authors.initials: DM
authors.lastname: Herron
authors.forename: L L
authors.initials: LL
authors.lastname: Swanström
authors.forename: N
authors.initials: N
authors.lastname: Ramzi
authors.forename: P D
authors.initials: PD
authors.lastname: Hansen
mesh_terms: D003680:Deglutition Disorders / Q000209:etiology*; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000601:surgery; D006801:Humans; D010535:Laparoscopy; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D012307:Risk Factors