title: On-table endoscopy following laparoscopic fundoplication.
abstract: BACKGROUND
  Laparoscopic fundoplication represents the gold standard in the surgical management of gastro-esophageal reflux disease (GERD). The achievement of long-lasting symptomatic and physiological control of reflux is the goal of therapy, as well as the minimization of troubling sequelae, in particular, dysphagia. On-table endoscopy after fundoplication was introduced in this Unit as a quality initiative in an attempt to minimize dysphagia and technical errors, and the aim of this study is to report the experience to date, and compare outcomes with the previous 100 cases performed by an experienced team.
  
  
  METHODS
  Eighty patients who underwent laparoscopic Rosetti-Nissen fundoplication and on-table endoscopy (group 2) were compared with 100 consecutive prior cases (group 1). Patients were prospectively evaluated and had pre- and postoperative symptom scoring and analysis of complications (all patients), and manometry and 24-h pH testing in 120 patients (60 in each group).
  
  
  RESULTS
  Both groups were similar with respect to demographics, esophagitis, pH score, and dysmotility. No bougie was used in either group. On-table endoscopy resulted in technical modifications in 4 (5%) patients. Early grade 2 or 3 dysphagia was evident in 4 (5%) patients in group 2, compared with 15 (15%) in group 1 (p < 0.001). Late dysphagia was evident in one patient (1.5%) in group 2 compared with 7 (7%) in group 1 (p < 0.05). Dilatation was performed in four patients (5%) in group 2, compared with 11 (11%) in group 1 (p < 0.05).
  
  
  CONCLUSIONS
  These data suggest that on-table endoscopy may be a useful quality assurance adjunct in laparoscopic anti-reflux surgery, in particular, reducing the incidence of dysphagia and reinterventions.
authors.affiliation: University Department of Surgery, Trinity Centre for Health Sciences, St. James' Hospital, Dublin 8, Ireland.
authors.forename: Narayanasamy
authors.initials: N
authors.lastname: Ravi
authors.forename: Nael
authors.initials: N
authors.lastname: Al-Sarraf
authors.forename: Paul
authors.initials: P
authors.lastname: Balfe
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Byrne
authors.forename: John V
authors.initials: JV
authors.lastname: Reynolds
mesh_terms: D003680:Deglutition Disorders / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D050782:Esophageal pH Monitoring; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000009:adverse effects* / Q000379:methods; D005764:Gastroesophageal Reflux / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008365:Manometry; D011183:Postoperative Complications; D011312:Pressure; D011446:Prospective Studies; D012086:Reoperation / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome