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Chronic dysphagia following laparoscopic fundoplication
J R Bessell1, R Finch, D C Gotley
1Department of Surgery, Mater Private Hospital, Royal Brisbane Hospital and Princess Alexandra Hospital, Brisbane, Australia.
The British Journal of Surgery
|October 24, 2000
Summary
Tailored antireflux surgery is unnecessary. Laparoscopic Nissen fundoplication is safe for patients with abnormal esophageal peristalsis, showing similar dysphagia rates to Toupet fundoplication.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Esophageal Motility Disorders
Background:
- Laparoscopic antireflux surgery is commonly performed to prevent postoperative dysphagia.
- Surgeons often tailor fundoplication degree based on patient esophageal peristalsis.
- The study investigates the impact of fundoplication type and esophageal function on dysphagia.
Purpose of the Study:
- To compare postoperative dysphagia rates after 360-degree (Nissen) and 270-degree (Toupet) laparoscopic fundoplication.
- To assess the influence of abnormal esophageal peristalsis on dysphagia following these procedures.
Main Methods:
- A cohort study involving 846 patients across three tertiary referral centers.
- Dysphagia was assessed before and 1 year after laparoscopic fundoplication.
- Preoperative esophageal manometry was conducted on all participants.
Main Results:
- Only 2% of patients reported severe postoperative dysphagia.
- Patients with normal esophageal motility showed improved dysphagia after Nissen fundoplication (P=0.02).
- No significant difference in dysphagia rates was observed for patients with abnormal esophageal motility regardless of fundoplication type.
Conclusions:
- A tailored approach to fundoplication degree is not necessary.
- Full laparoscopic Nissen fundoplication can be safely performed in patients with esophageal dysmotility.
- Dysphagia rates are comparable between Nissen and Toupet fundoplication in patients with abnormal esophageal peristalsis.