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|Title:||Impact of ineffective oesophageal motility and wrap type on dysphagia after laparoscopic fundoplication|
|Citation:||British Journal of Surgery, 2011; 98(10):1414-1421|
|Publisher:||John Wiley & Sons Ltd|
|J.A. Broeders, I.G. Sportel, G.G. Jamieson, R.S. Nijjar, N. Granchi, J.C. Myers and S.K. Thompson|
|Abstract:||BACKGROUND: Laparoscopic 360° fundoplication is the most common operation for gastro-oesophageal reflux disease, but is associated with postoperative dysphagia in some patients. Patients with ineffective oesophageal motility may have a higher risk of developing postoperative dysphagia, but this remains unclear. METHODS: From 1991 to 2010, 2040 patients underwent primary laparoscopic fundoplication for gastrooesophageal reflux disease and met the study inclusion criteria; 343 had a 90°, 498 a 180° and 1199 a 360° fundoplication. Primary peristalsis and distal contraction amplitude during oesophageal manometry were determined for 1354 patients. Postoperative dysphagia scores (range 0–45) were recorded at 3 and 12 months, then annually. Oesophageal dilatations and/or reoperations for dysphagia were recorded. RESULTS: Preoperative oesophageal motility did not influence postoperative dysphagia scores, the need for dilatation and/or reoperation up to 6 years. Three-month dysphagia scores were lower after 90° and 180° compared with 360° fundoplication (mean(s.e.m.) 8•0(0•6) and 9•8(0•5) respectively versus 11•9(0•4); P < 0•001 and P = 0•003), but these differences diminished after 6 years of follow-up. The incidence of dilatation and reoperation for dysphagia was lower after 90° (2•6 and 0•6 per cent respectively) and 180° (4•4 and 1•0 per cent) fundoplications than with a 360° wrap (9•8 and 6•8 per cent; both P < 0•001 versus 90° and 180° groups). CONCLUSION: Tailoring the degree of fundoplication according to preoperative oesophageal motility by standard manometric parameters has no long-term impact on postoperative dysphagia. There is, however, a proportionate increase in short-term dysphagia scores with increasing degree of wrap, and a corresponding proportionate increase in dilatations and reoperations for dysphagia. These differences in dysphagia scores diminish with time.|
|Keywords:||Humans; Esophageal Motility Disorders; Gastroesophageal Reflux; Postoperative Complications; Treatment Failure; Esophagostomy; Fundoplication; Reoperation; Dilatation; Manometry; Adult; Aged; Aged, 80 and over; Middle Aged; Female; Male; Young Adult; Kaplan-Meier Estimate|
|Rights:||Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.|
|Appears in Collections:||Surgery publications|
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