Evaluation of post-operative dysphagia following anti-reflux surgery

Greenberg, June; Stefanova, Dessislava; Reyes, Fernando Valle; Edelmuth, Rodrigo C. L.; Harik, Lamia G.; Thiesmeyer, Jessica W.; Egan, Caitlin E.; Palacardo, Federico; Liu, Mengyuan; Christos, Paul J.; Schnoll‐Sussman, Felice; Katz, Philip O.; Finnerty, Brendan M.; Fahey, Thomas J.; Zarnegar, Rasa

doi:10.1007/s00464-021-08888-y

Cited by 11 publications

(6 citation statements)

References 22 publications

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“…Persistent post-operative dysphagia, refractory to diet and multiple dilations, is a complex multi-faceted problem involving esophageal motility, device size, host response to implant, and individual subjective perception of dysphagia, all of which warrant further esophageal testing [ 23 ]. Endoscopy may reveal normal resistance at the EGJ, but marked resistance may indicate the formation of robust scar tissue surrounding the EGJ.…”

Section: Discussionmentioning

confidence: 99%

Removal of the magnetic sphincter augmentation device: an assessment of etiology, clinical presentation, and management

et al. 2023

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Background Magnetic sphincter augmentation (MSA) erosion, disruption or displacement clearly requires device removal. However, up to 5.5% of patients without anatomical failure require removal for dysphagia or recurrent GERD symptoms. Studies characterizing these patients or their management are limited. We aimed to characterize these patients, compare their outcomes, and determine the necessity for further reflux surgery. Methods This is a retrospective review of 777 patients who underwent MSA at our institution between 2013 and 2021. Patients who underwent device removal for persistent dysphagia or recurrent GERD symptoms were included. Demographic, clinical, objective testing, and quality of life data obtained preoperatively, after implantation and following removal were compared between removal for dysphagia and GERD groups. Sub-analyses were performed comparing outcomes with and without an anti-reflux surgery (ARS) at the time of removal. Results A total of 40 (5.1%) patients underwent device removal, 31 (77.5%) for dysphagia and 9 (22.5%) for GERD. After implantation, dysphagia patients had less heartburn (12.9-vs-77.7%, p = 0.0005) less regurgitation (16.1-vs-55.5%, p = 0.0286), and more pH-normalization (91.7-vs-33.3%, p = 0.0158). Removal without ARS was performed in 5 (55.6%) GERD and 22 (71.0%) dysphagia patients. Removal for dysphagia patients had more complete symptom resolution (63.6-vs-0.0%, p = 0.0159), freedom from PPIs (81.8-vs-0.0%, p = 0.0016) and pH-normalization (77.8-vs-0.0%, p = 0.0455). Patients who underwent removal for dysphagia had comparable symptom resolution (p = 0.6770, freedom from PPI (p = 0.3841) and pH-normalization (p = 0.2534) with or without ARS. Those who refused ARS with removal for GERD had more heartburn (100.0%-vs-25.0%, p = 0.0476), regurgitation (80.0%-vs-0.0%, p = 0.0476) and PPI use (75.0%-vs-0.0%, p = 0.0476). Conclusions MSA removal outcomes are dependent on the indication for removal. Removal for dysphagia yields excellent outcomes regardless of anti-reflux surgery. Patients with persistent GERD had worse outcomes on all measures without ARS. We propose a tailored approach to MSA removal-based indication for removal. Graphical abstract

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Section: Discussionmentioning

confidence: 99%

Removal of the magnetic sphincter augmentation device: an assessment of etiology, clinical presentation, and management

et al. 2023

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“…[5][6][7][8][9] LF has been associated with various side effects, however, including dysphagia and dumping syndrome, which may reduce the effectiveness of surgery and patients' willingness to choose this treatment. [10][11][12] In a minority of cases, LF may also fail to achieve symptom relief or mucosal healing, so that patients have to continue medical treatment or undergo surgery again. 13,14 Understanding the reasons behind surgical failures and identifying predictors of a positive outcome after surgery have been the object of research for some time.…”

Section: Introductionmentioning

confidence: 99%

Manometric identikit of a functioning and effective fundoplication for gastroesophageal reflux disease in the high‐resolution manometry ERA

Salvador,

Capovilla,

Santangelo

et al. 2024

UEG Journal

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BackgroundThe pathophysiological and clinical value of performing High‐Resolution Manometry (HRM) after laparoscopic fundoplication (LF) for gastroesophageal reflux disease (GERD) is still unclear and debated.ObjectiveWe sought to establish the HRM parameters indicative of functioning fundoplications, and whether HRM could distinguish them from tight or defective ones.MethodsThe study involved patients with GERD who underwent laparoscopic Nissen (LN) or Toupet (LT) fundoplication between 2010 and 2022. HRM and 24‐h pH monitoring were performed before and 6 months after surgery. The study population was divided into 5 groups: LN and LT patients with normal 24h‐pH findings (LNpH‐ and LTpH‐, respectively); LN and LT patients with pathological 24h‐pH findings (LNpH+ and LTpH + groups, respectively); and patients with a postoperative dysphagia intensity score >2 (Dysphagia group). The novel Hiatal Morphology (HM) classification was applied, envisaging 3 different subtypes: HM1 (normal), HM2 (intrathoracic fundoplication), and HM3 (slipped fundoplication).ResultsAmong the 132 patients recruited during the study period, 46 were in the LNpH‐ group, 51 in the LTpH‐ group, 15 in the LNpH + group, 7 in the LTpH + group, and 5 in the Dysphagia group. In multivariate analysis, postoperative abdominal lower esophageal sphincter length (p = 0.001) and HM2 (p < 0.001) were both independently associated with surgical failure. Integrated relaxation pressure was significantly higher in the Dysphagia group than in the LNpH‐ group.ConclusionThis study generated reference HRM values for an effective LF, and confirms that using HRM to assess the neo‐sphincter and HM improves the clinical assessment in cases of symptom recurrence.

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“…Postoperative pneumonia [1][2][3][4][5][6][7][8][9] is the third most common side-effect of surgery (regardless of the procedure 10,11 ), however there is limited data on the mechanism of this outcome. Two other common risk factors for hospital and community acquired pneumonia are use of opioids 12 and presence of a swallow disorder (dysphagia) 13 .…”

Section: Introductionmentioning

confidence: 99%

Dysphagia as a missing link between post-surgical- and opioid-related pneumonia

Frazure,

Greene,

Iceman

et al. 2023

Preprint

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Objective: Postoperative pneumonia remains a common complication of surgery, despite increased attention. The purpose of our study was to determine the effects of routine surgery and post-surgical opioid administration on airway protection risk. Methods: Eight healthy adult cats were evaluated for dysphagia in 2 experiments. 1) In 4 female cats airway protection status was tracked following routine abdominal surgery (spay surgery) plus low-dose opioid administration (buprenorphine 0.015mg/kg, IM, q8-12h; n=5). 2) Using a cross-over design (2 male, 2 female) cats were treated with moderate (0.02mg/kg) or high (0.04mg/kg) dose buprenorphine (IM, q8-12h; n=5) to determine changes in airway protection status or evidence of dysphagia. Results: Airway protection was significantly affected in both experiments, but most severely post-surgically where 75% of the animals exhibited silent aspiration. Conclusion: Oropharyngeal swallow is impaired by the partial mu-opioid receptor agonist buprenorphine, most remarkably in the post-operative setting. These findings have implications for the prevention and management of aspiration pneumonia in vulnerable populations.

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Evaluation of post-operative dysphagia following anti-reflux surgery

Cited by 11 publications

References 22 publications

Removal of the magnetic sphincter augmentation device: an assessment of etiology, clinical presentation, and management

Removal of the magnetic sphincter augmentation device: an assessment of etiology, clinical presentation, and management

Manometric identikit of a functioning and effective fundoplication for gastroesophageal reflux disease in the high‐resolution manometry ERA

Dysphagia as a missing link between post-surgical- and opioid-related pneumonia

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