Causes of long-term dysphagia after laparoscopic Nissen fundoplication.
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.


METHODS
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.
Sato
Kazuyoshi
K
Department of Surgery, Creighton University School of Medicine, Omaha, Nebraska 68131-2197, USA.
Awad
Ziad T
ZT
Filipi
Charles J
CJ
Selima
Mohamed A
MA
Cummings
Judd E
JE
Fenton
Steve J
SJ
Hinder
Ronald A
RA
D000328:Adult; D000368:Aged; D003680:Deglutition Disorders / Q000209:etiology* / Q000628:therapy; D005260:Female; D018662:Fundoplication / Q000009:adverse effects*; D005764:Gastroesophageal Reflux / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012086:Reoperation