Document Detail


Laparoscopic Nissen fundoplication is a good option in patients with abnormal esophageal motility.
MedLine Citation:
PMID:  19172353     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Patients with gastroesophageal reflux disease (GERD) and abnormal esophageal motility are the most controversial subgroup of surgically treated patients because of potentially increased risk of postoperative dysphagia. Our study aim was to determine if Nissen fundoplication is associated with increased postoperative dysphagia in patients with ineffective esophageal motility. METHODS: Medical records of all adult (>18 years old) patients who underwent laparoscopic Nissen fundoplication for GERD over 8 years were reviewed retrospectively. Of the 151 patients, 28 (group A) met manometric criteria for abnormal esophageal motility (<30 mmHg mean contractile pressure or <80% peristalsis), whereas 63 (group B) had normal esophageal function. Sixty patients had no manometric data and were therefore excluded from analysis. Follow-up time ranged from 1 month to 5 years. Outcomes (postoperative dysphagia, recurrence of GERD symptoms, free of medications) were compared between groups. RESULTS: Group A had higher age and American Society of Anesthesiologists (ASA) score (p = 0.016 and 0.020), but this did not correlate with outcome. Two patients (7.1%) in group A and three patients (5.3%) in group B had postoperative dysphagia. When adjusted for follow-up time, there was no significant difference between the groups (p = 0.94). Group B had more cases of recurrent heartburn (10.7% versus 3.6%, p = 0.039), and more patients in this group were back on medications (21.4% versus 7.1%, p < 0.05) CONCLUSIONS: This retrospective study found equally low rates of dysphagia following Nissen fundoplication regardless of baseline esophageal motility. Preoperative esophageal dysmotility therefore does not seem to be a contraindication for laparoscopic Nissen fundoplication.
Authors:
Zurab Tsereteli; Emanuel Sporn; J Andres Astudillo; Brent Miedema; William S Eubanks; Klaus Thaler
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Publication Detail:
Type:  Journal Article     Date:  2009-01-27
Journal Detail:
Title:  Surgical endoscopy     Volume:  23     ISSN:  1432-2218     ISO Abbreviation:  Surg Endosc     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-10-13     Completed Date:  2010-02-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8806653     Medline TA:  Surg Endosc     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  2292-5     Citation Subset:  IM    
Affiliation:
Department of General Surgery, University of Missouri, One Hospital Drive, Columbia, MO 65212, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Chi-Square Distribution
Deglutition Disorders / etiology
Esophageal Motility Disorders / complications,  surgery*
Esophagoscopy*
Female
Fundoplication* / adverse effects
Gastroesophageal Reflux / complications,  surgery*
Humans
Male
Manometry
Middle Aged
Postoperative Complications / etiology
Retrospective Studies
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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