Early esophageal transit study after laparoscopic fundoplication: how useful is it?
BACKGROUND
Early complications of laparoscopic fundoplication, if immediately recognized, may be promptly treated laparoscopically with minimal morbidity. A suggested strategy for identification is a routine postoperative esophageal transit study.


OBJECTIVE
To investigate the role of early postoperative esophagogram with Gastrografin in predicting major complications, failures, or severe dysphagia.


METHODS
Esophagograms performed in 92 patients, 24 hours after laparoscopic fundoplication, were correlated to major complications. Esophageal transit time was scored and correlated with dysphagia.


RESULTS
Esophagogram detected two of three observed complications: acute paraesophageal hernia and intrathoracic migration, but not a fundic perforation. Only a severe transit impairment predicted a disabling dysphagia (specificity 82%, sensitivity 70%).


CONCLUSIONS
Postoperative swallow is an appropriate investigation to diagnose anatomical abnormalities but may be deceptive for perforations. Severe transit delay may predict the risk of severe dysphagia. Although useful, postoperative routine transit studies would probably not change the therapeutic strategies in most patients.
Contini
Sandro
S
Department of General Surgery and Organ Transplantation, School of Medicine and Dentistry, University of Parma, Maggiore University Hospital, Via Gramsci 14, 43100, Parma, Italy. continis@unipr.it
Scarpignato
Carmelo
C
D000328:Adult; D000368:Aged; D003287:Contrast Media; D003680:Deglutition Disorders / Q000000981:diagnostic imaging* / Q000209:etiology*; D003974:Diatrizoate Meglumine / Q000494:pharmacology; D004945:Esophagoscopy; D004947:Esophagus / Q000000981:diagnostic imaging / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000009:adverse effects* / Q000379:methods; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011184:Postoperative Period; D011336:Probability; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment
D003287:Contrast Media; D003974:Diatrizoate Meglumine