title: Laparoscopic Nissen fundoplication is a good option in patients with abnormal esophageal motility.
abstract: BACKGROUND
  Patients with gastroesophageal reflux disease (GERD) and abnormal esophageal motility are the most controversial subgroup of surgically treated patients because of potentially increased risk of postoperative dysphagia. Our study aim was to determine if Nissen fundoplication is associated with increased postoperative dysphagia in patients with ineffective esophageal motility.
  
  
  METHODS
  Medical records of all adult (>18 years old) patients who underwent laparoscopic Nissen fundoplication for GERD over 8 years were reviewed retrospectively. Of the 151 patients, 28 (group A) met manometric criteria for abnormal esophageal motility (<30 mmHg mean contractile pressure or <80% peristalsis), whereas 63 (group B) had normal esophageal function. Sixty patients had no manometric data and were therefore excluded from analysis. Follow-up time ranged from 1 month to 5 years. Outcomes (postoperative dysphagia, recurrence of GERD symptoms, free of medications) were compared between groups.
  
  
  RESULTS
  Group A had higher age and American Society of Anesthesiologists (ASA) score (p = 0.016 and 0.020), but this did not correlate with outcome. Two patients (7.1%) in group A and three patients (5.3%) in group B had postoperative dysphagia. When adjusted for follow-up time, there was no significant difference between the groups (p = 0.94). Group B had more cases of recurrent heartburn (10.7% versus 3.6%, p = 0.039), and more patients in this group were back on medications (21.4% versus 7.1%, p < 0.05)
  
  
  CONCLUSIONS
  This retrospective study found equally low rates of dysphagia following Nissen fundoplication regardless of baseline esophageal motility. Preoperative esophageal dysmotility therefore does not seem to be a contraindication for laparoscopic Nissen fundoplication.
authors.affiliation: Department of General Surgery, University of Missouri, One Hospital Drive, Columbia, MO 65212, USA.
authors.forename: Zurab
authors.initials: Z
authors.lastname: Tsereteli
authors.forename: Emanuel
authors.initials: E
authors.lastname: Sporn
authors.forename: J Andres
authors.initials: JA
authors.lastname: Astudillo
authors.forename: Brent
authors.initials: B
authors.lastname: Miedema
authors.forename: William S
authors.initials: WS
authors.lastname: Eubanks
authors.forename: Klaus
authors.initials: K
authors.lastname: Thaler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003680:Deglutition Disorders / Q000209:etiology; D015154:Esophageal Motility Disorders / Q000150:complications / Q000601:surgery*; D004945:Esophagoscopy; D005260:Female; D018662:Fundoplication / Q000009:adverse effects; D005764:Gastroesophageal Reflux / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome