Document Detail


Analysis and surgical treatment of persistent dysphagia after Nissen fundoplication.
MedLine Citation:
PMID:  11298627     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: After Nissen fundoplication, troublesome dysphagia develops in 5-10 per cent of patients. The mechanism of dysphagia has not been fully resolved, in spite of a number of studies focusing on oesophageal motility and lower oesophageal sphincter (LOS) dynamics. Tightness and length of the wrap have had considerable attention, without giving a fully satisfactory explanation of the pathophysiological mechanism. METHODS: Eighteen patients with persistent dysphagia after Nissen fundoplication needing reoperation were studied. Eighteen patients, matched for age and sex, without dysphagia after Nissen fundoplication were used as controls. Reoperation consisted of conversion of a 360 degrees into a 270 degrees wrap. Barium swallow, endoscopy, oesophageal manometry and 24-h pH monitoring were performed before and after (re)operation. RESULTS: Peristaltic amplitude, velocity and duration of contraction were not significantly influenced by operation. In 16 of 18 patients with dysphagia, LOS relaxation was incomplete and the residual relaxation pressure was significantly higher than that in the group without dysphagia (P < 0.01). No correlation was found between LOS pressure and peristaltic amplitude, nor between LOS pressure and ramp pressure in the distal oesophagus. After reoperation, basal LOS pressure decreased significantly (P < 0.01) and LOS relaxation was complete in all but three patients; residual relaxation pressure decreased (P < 0.01) and was significantly lower than that after uncomplicated Nissen fundoplication. In the latter group, LOS pressure, residual relaxation pressure and ramp pressure increased significantly after operation (P < 0.01). CONCLUSION: A return to complete LOS relaxation and a decrease in residual relaxation pressure play an important role in resolving dysphagia.
Authors:
J E Bais; B P Wijnhoven; A A Masclee; A J Smout; H G Gooszen
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The British journal of surgery     Volume:  88     ISSN:  0007-1323     ISO Abbreviation:  Br J Surg     Publication Date:  2001 Apr 
Date Detail:
Created Date:  2001-04-12     Completed Date:  2001-04-26     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0372553     Medline TA:  Br J Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  569-76     Citation Subset:  AIM; IM    
Affiliation:
Gastrointestinal Research Unit, University Medical Center Utrecht, Utrecht, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Chronic Disease
Deglutition Disorders / etiology,  physiopathology,  surgery*
Esophagoscopy / methods
Female
Fundoplication / adverse effects*,  methods
Gastrointestinal Motility / physiology
Humans
Hydrogen-Ion Concentration
Male
Manometry
Middle Aged
Peristalsis / physiology
Pressure
Reoperation

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