Dysphagia after antireflux fundoplication: endoscopic, radiological and manometric evaluation

Abstract

BackgroundThe transient dysphagia after fundoplication is common and most often disappears until six weeks postoperatively.AimAnalyze a group of patients who presented late and persistent dysphagia postoperatively.MethodsForty-one patients after Nissen fundoplication, 14 male and 27 female, mean age 48 year, were evaluated based on medical history, esophagogastroduodenoscopy, contrast radiographic examination and esophageal manometry. The results were compared with another 19 asymptomatic individuals.ResultsContrast radiographic examination of the esophagus revealed in six cases delayed emptying, characterizing that four patients had achalasia and two diffuse spasm of the esophagus. Esophageal manometry showed that maximal expiratory pressure of the lower sphincter ranged from 10 to 38 mmHg and mean respiratory pressure from 14 to 47 mmHg, values similar to controls. Residual pressure ranged from 5 to 31 mmHg, and 17 patients had the same values as the control group.ConclusionThe residual pressure of the lower sphincter was higher and statistically significant in patients with dysphagia compared with those operated without dysphagia. Future studies individualizing and categorizing each motility disorder, employing other techniques of manometry, and the analysis of the residual pressure may contribute to understand of persistent dysphagia in the postoperative fundoplication.

A Pictorial Presentation of Esophageal High Resolution Manometry Current Parameters

“…Conventional manometry classifies peristalsis based on the propagation and velocity of the waves ( Figure 4 A) 10 . HRM created the distal latency (DL) parameter that measures the peristalsis velocity from the beginning of the swallow to the epiphrenic ampulla.…”

Tailored modern GERD therapy – steps towards the development of an aid to guide personalized anti-reflux surgery

“…The reason why the assessment of the preoperative esophageal motility based on the EFTs was our most important factor for indicating the type of surgical GERD-treatment can be explained knowing that the most feared complication of anti-reflux surgery is dysphagia, persisting beyond 8 weeks postoperatively. Still not fully understood, possible risk factors for its development are believed to be a tight hiatus or slipped fundoplication, as well as preoperative esophageal motility disorders 13,34,35 . Hence, the first step in avoiding this adverse effect lies in the correct preoperative diagnostics and choice of operative management.…”

Late Evaluation of Patients Operated for Gastroesophageal Reflux Disease by Nissen Fundoplication

“…Nissen fundoplication provides good short-term outcomes, although the risk of adverse events and complications is more prevalent than in clinical treatment 22 , 26 , 28 . Apparently, the long-term outcomes are also good, at least in terms of quality of life 1 , 5 , 14 , despite the need for some antireflux drug, a fact also observed in the present study.…”

“…Surgical treatment of GERD by Nissen fundoplication is effective and safe, providing good results in the control of the disease 8 , 9 , 19 , 27 , 31 . Dysphagia, gas bloat syndrome and the inability to vomit are frequently reported by patients after surgery 22 , 26 . However, some authors have questioned the efficacy of this procedure 28 and few studies on the long-term outcomes of these patients are available in the literature, especially in Brazil.…”