Impact of ineffective oesophageal motility and wrap type on dysphagia after laparoscopic fundoplication

Broeders, Joris A.; Sportel, I. G.; Jamieson, Glyn G.; Nijjar, Rajwinder; Granchi, Nelson; Myers, Jennifer C.; Thompson, Sarah K.

doi:10.1002/bjs.7573

Cited by 49 publications

(23 citation statements)

References 72 publications

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“…6 Our results are in line with studies done by other researchers showing that dysphagia can affect up to 90% of post-fundoplication patients. 5,10,11,22 In patients after antireflux procedure there can be other factors contributing to dysphagia, such as individual lower sensory threshold during bolus distension, surgery-related factors like degree, tightness, and length of fundoplication wrap. 5,9,11 The most precise measuring methods of HRM still do not result in better understanding of correlation between motility, bolus transport and symptoms like dysphagia.…”

Section: Discussionmentioning

confidence: 99%

High-resolution Manometry in Patients with Gastroesophageal Reflux Disease Before and After Fundoplication

Rerych

Kurek²,

Klimacka-Nawrot

et al. 2017

J Neurogastroenterol Motil

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Background/AimsThe study aimed to determine pre-and post-fundoplication esophagogastric junction (EGJ) pressure and esophageal peristalsis by high-resolution manometry (HRM) in patients with gastroesophageal reflux disease (GERD). MethodsPre-operative and post-operative HRM data from 25 patients with GERD were analyzed using ManoView version 2.0.1. with updated software for Chicago classification and pressure topography. The study involved swallowing water boluses of 10 mL in the upright position. ResultsSignificant increase of mean basal EGJ pressure and minimal basal EGJ pressure was found in post-operative as compared with preoperative patients (P < 0.05 and P < 0.001, respectively). Integrated relaxation pressure (IRP) reached higher values in post-operative patients than in pre-operative patients (P < 0.001). Intra-bolus pressure (IBP) was significantly higher (P < 0.05) and contractile front velocity (CFV) was slower (P < 0.01) in post-operative patients than in pre-operative patients. Moreover significant increase of distal contractile integral (DCI) was found in post-operative patients (P < 0.05). Hiatal hernia was detected by HRM in 11 pre-operative patients. Fifteen out of 25 post-operative patients complained of dysphagia. ConclusionsFundoplication restores the antireflux barrier by reinforcing EGJ basal pressures, repairing hiatal hernias, and enhances peristaltic function of the esophagus by increasing DCI. However slight IRP elevation found in post-fundoplication patients may result in bolus pressurization and motility disorders.

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Section: Discussionmentioning

confidence: 99%

High-resolution Manometry in Patients with Gastroesophageal Reflux Disease Before and After Fundoplication

Rerych

Kurek²,

Klimacka-Nawrot

et al. 2017

J Neurogastroenterol Motil

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“…Preoperative dysphagia (odds ratio: 4.4) and preoperative delayed esophageal transit of barium swallows (odds ratio: 8.2) are risk factors for postoperative dysphagia (30) . Preoperative esophageal dysmotility does not seem to be a cause of persistent dysphagia after operation (4,30) . Others investigations found that before the surgery there is a greater and faster compression of a swallowed viscous bolus, with less bolus flow, in patients who will have postfundoplication dysphagia, suggesting that dysphagia is related to a preexisting subclinical variation of esophageal function (21,22) .…”

Section: Discussionmentioning

confidence: 79%

“…In almost all patients, dysphagia is a post-treatment complication that lasts for about 6 weeks and then disappears, while in some, the complication persist beyond 6 weeks (4,31) . Some patients have persistent dysphagia, which may be of significant intensity and compromise the patient's quality of life (17) .…”

Section: Introductionmentioning

confidence: 99%

Postfundoplication Dysphagia Causes Similar Water Ingestion Dynamics as Achalasia

Dantas

Santos

Cassiani

et al. 2016

Arq. Gastroenterol.

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-Background -After surgical treatment of gastroesophageal reflux disease dysphagia is a symptom in the majority of patients, with decrease in intensity over time. However, some patients may have persistent dysphagia. Objective -The objective of this investigation was to evaluate the dynamics of water ingestion in patients with postfundoplication dysphagia compared with patients with dysphagia caused by achalasia, idiopathic or consequent to Chagas' disease, and controls. Methods -Thirty-three patients with postfundoplication dysphagia, assessed more than one year after surgery, together with 50 patients with Chagas' disease, 27 patients with idiopathic achalasia and 88 controls were all evaluated by the water swallow test. They drunk, in triplicate, 50 mL of water without breaks while being precisely timed and the number of swallows counted. Also measured was: (a) inter-swallows interval -the time to complete the task, divided by the number of swallows during the task; (b) swallowing flow -volume drunk divided by the time taken; (c) volume of each swallow -volume drunk divided by the number of swallows. Results -Patients with postfundoplication dysphagia, Chagas' disease and idiopathic achalasia took longer to ingest all the volume, had an increased number of swallows, an increase in interval between swallows, a decrease in swallowing flow and a decrease in water volume of each swallow compared with the controls. There was no difference between the three groups of patients. There was no correlation between postfundoplication time and the results. Conclusion -It was concluded that patients with postfundoplication dysphagia have similar water ingestion dynamics as patients with achalasia.

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“…ARS can be accompanied by VNI, a complication that may negatively affect the overall outcome of the procedure [9,12,13,14]. Because little is known on the prevalence of VNI after ARS, an extensive review of the existing literature was performed.…”

Section: Discussionmentioning

confidence: 99%

“…With these procedures, excellent results have been obtained regarding symptomatic outcome and safety on both short- and long-term follow-up [6,7,8,9,10,11]. Despite these encouraging results, ARS is still accompanied by specific surgery-related peri- and postoperative complications and by unwanted postoperative symptoms [9,12,13,14]. …”

Section: Introductionmentioning

confidence: 99%

Effect of Vagus Nerve Injury on the Outcome of Antireflux Surgery: An Extensive Literature Review

Rijn

Roebroek²,

Conchillo³

et al. 2016

Dig Surg

154

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Background: Vagus nerve injury (VNI) is a feared complication of antireflux surgery (ARS). The impact of VNI on the functional outcomes of ARS has not yet been evaluated systematically. The aim of this review was to evaluate the impact of VNI on functional and clinical outcome of ARS. Methods: A systematic search was performed until March 2015, using the following online databases: MEDLINE, Embase and the Cochrane Register of Controlled Clinical Trials. Eight studies remained available for assessment. Articles were divided into 2 groups: (a) one with unintended, accidental VNI and (b) one group comparing ARS with and without intended vagotomy. Results: The prevalence of unintended, accidental VNI ranged from 10 to 42% after ARS. No clear differences were seen in outcome for reflux control between the VNI and vagus nerve intact group. A higher prevalence of diarrhea, nausea and vomiting was observed in the VNI group. Conclusion: VNI is a feared but neglected complication of ARS. Larger prospective studies that objectively assess vagus nerve integrity before and after ARS are needed.

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Impact of ineffective oesophageal motility and wrap type on dysphagia after laparoscopic fundoplication

Cited by 49 publications

References 72 publications

High-resolution Manometry in Patients with Gastroesophageal Reflux Disease Before and After Fundoplication

High-resolution Manometry in Patients with Gastroesophageal Reflux Disease Before and After Fundoplication

Postfundoplication Dysphagia Causes Similar Water Ingestion Dynamics as Achalasia

Effect of Vagus Nerve Injury on the Outcome of Antireflux Surgery: An Extensive Literature Review

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