| 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 |
Related Documents
:
|
3605507 - Surgical treatment of the gastroesophageal reflux syndrome in infants and children. 9252517 - Effect of cholecystokinin-a receptor blockade on lipid-induced gastric relaxation in hu... 3985147 - Variability of lower esophageal sphincter pressure in the fasted unanesthetized opossum. 6479537 - Change in bile duct pressure responses after cholecystectomy: loss of gallbladder as a ... 2011987 - Validity of an early postoperative baseline doppler recording after aortic valve replac... 3605507 - Surgical treatment of the gastroesophageal reflux syndrome in infants and children. |
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. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| 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 |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Expression of gastrin in developing gastric adenocarcinoma.
Next Document: Laparoscopic antireflux surgery in the treatment of the acid-sensitive oesophagus.