Esophageal ileus following laparoscopic fundoplication

Area of Science:

• Gastroenterology
• Surgical Innovation
• Esophageal Physiology

Background:

• Dysphagia is common after laparoscopic fundoplication, but its link to esophageal motor function changes is unclear.
• Early postoperative esophageal motility following fundoplication has not been previously assessed.
• Understanding these changes is crucial for managing patient recovery and outcomes.

Purpose of the Study:

• To evaluate early postoperative esophageal motor function after laparoscopic fundoplication.
• To compare esophageal motility in fundoplication patients versus a control group.
• To investigate the temporal recovery of esophageal peristalsis.

Main Methods:

• Esophageal manometry was performed on postoperative day 1 in 10 fundoplication patients and 10 control (cholecystectomy) patients.
• Standard perfusion manometry assessed primary peristalsis during water swallows.
• Follow-up manometry was conducted at 3 months in nine fundoplication patients.

Main Results:

• Fundoplication patients showed significantly reduced primary peristalsis (5% success) compared to controls (100% success) on day 1 (P=0.05).
• Failure of primary esophageal peristalsis occurred in 70% of fundoplication patients versus 20% of controls.
• At 3 months, peristalsis improved in most patients, though two remained aperistaltic.

Conclusions:

• Laparoscopic fundoplication causes significant, temporary esophageal motor dysfunction (esophageal ileus) in the early postoperative period.
• Esophageal motility demonstrates a trend toward recovery by 3 months post-surgery.
• These findings highlight a transient 'esophageal ileus' following fundoplication, impacting early swallowing function.