Identificação de fatores de risco pré-operatórios para disfagia pós-operatória persistente após cirurgia laparoscópica para doença do refluxo gastroesofágico

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. Aim: 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. RESUMO -Racional:Disfagia no pós-operatório é comum após a operação anti-refluxo. No entanto, uma parte dos pacientes relatam disfagia persistente, e técnica cirúrgica inadequada é uma causa bem documentada deste resultado. Objetivo: Este estudo retrospectivo avaliou os fatores de risco no pré-operatório para a disfagia persistente após operação antirefluxo por via laparoscópica. Métodos: Pacientes submetidos à operação anti-refluxo por via laparoscópica pela técnica de Nissen modificada foram avaliados no pré-operatório de forma retrospectiva. A severidade da disfagia pós-operatória foi avaliada prospectivamente usando uma escala estabelecida. A disfagia após seis semanas foi definida como persistente. Os testes estatísticos de associação e regressão logística foram utilizados para identificar os fatores de risco associados à disfagia persistente. Resultados: Um total de 55 pacientes foram submetidos ao procedimento por via laparoscópica por uma única equipe de cirurgiões. Destes, 25 doentes referiam disfagia pré-operató...

Evaluation of the Outcomes of Anti-Reflux Surgery in the Management of Extraoesophageal Symptoms of Gastro-oesophageal Reflux Disease

“…One of the most common immediate postoperative side effect of antireflux surgery is temporary dysphagia which gradually improved over six weeks and would persist in about 2-5% of the patients (17,18) , temporary dysphagia was typically encountered in about 44% of our patients, however; neither of them has persistent dysphagia beyond 6 weeks.…”

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

“…The short- and long-term outcomes of surgical treatment of GERD depend on different factors, including the indication for surgery because of clinical untreatability, adequate anamnesis, supplementary tests demonstrating the presence of gastroesophageal reflux, surgery observing the technical steps, and postoperative care and instructions 2 , 13 , 26 .…”

“…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.…”

Laparoscopic antireflux surgery in patients with extra esophageal symptoms related to asthma

“…Dysphagia is one of the most common side effects of laparoscopic antireflux surgery in the immediate postoperative period, usually improving the first six weeks after surgery. The persistent dysphagia may occur in 2-5% of the patients 2 , 4 , 11 . In this study 15 (50%) of the patients already had symptoms in the preoperative evaluation, with no significant reduction in the postoperative period of approximately six months (T1, 50% versus T2, 23.08%, p=0.0522), probably due to esophageal dismotility.…”