title: Identification of preoperative risk factors for persistent postoperative dysphagia after laparoscopic antireflux surgery.
abstract: BACKGROUND
  Postoperative dysphagia is common after antireflux surgery and generally runs a self-limiting course. Nevertheless, part of these patients report long-term dysphagia. Inadequate surgical technique is a well documented cause of this result.
  
  
  OBJECTIVE
  This retrospective study evaluated the preoperative risk factors not surgery-related for persistent dysphagia after primary laparoscopic antireflux surgery.
  
  
  METHODS
  Patients who underwent laparoscopic antireflux surgery by the modified technique of Nissen were evaluated in the preoperative period retrospectively. Postoperative severity of dysphagia was evaluated prospectively using a stantardized scale. Dysphagia after six weeks were defined as persistent. Statistical tests of association and logistic regression were used to identify risk factors associated with persistent dysphagia.
  
  
  RESULTS
  A total of 55 patients underwent primary antireflux surgery by a single surgeon team. Of these, 25 patients had preoperative dysphagia (45,45%). Persistent postoperaive dysphagia was reported by 20 (36,36%). Ten patients (18,18%) required postoperative endoscopic dilatation for dysphagia. There was statistical association between satisfaction with surgery and postoperative dysphagia and requiring the use of antireflux medication after the procedure; and between preoperative dysphagia and postoperative dysphagia. Logistic regression identified significant preopertive dysphagia as risk factor for persistent postoperative dysphagia. No correlations were found with preoperative manometry.
  
  
  CONCLUSIONS
  Patients with significant preoperative dysphagia were more likely to report persistent postoperative dysphagia. This study confirms that the current manometric criteria used to define esophageal dysmotility are not reliable to identify patients at risk for post-fundoplication dysphagia. Minucious review of the clinical history about the presence and intensity of preoperative dysphagia is important in the selection of candidates for antireflux surgery.
authors.forename: Maxwel Capsy Boga
authors.initials: MC
authors.lastname: Ribeiro
authors.forename: Valdir
authors.initials: V
authors.lastname: Tercioti-Júnior
authors.forename: João Coelho de
authors.initials: JC
authors.lastname: Souza-Neto
authors.forename: Luiz Roberto
authors.initials: LR
authors.lastname: Lopes
authors.forename: Drausio Jefferson
authors.initials: DJ
authors.lastname: Morais
authors.forename: Nelson Adami
authors.initials: NA
authors.lastname: Andreollo
mesh_terms: D000328:Adult; D000368:Aged; D003680:Deglutition Disorders / Q000453:epidemiology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D057234:Preoperative Period; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors