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Evaluation of Dysphagia after Laparascopic Antireflux Surgery in Patients with Ineffective Esophageal Motility

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Khan, Nabeel H., M.D.; Khan, Amna H., M.D.

American Journal of Gastroenterology: September 2005 - Volume 100 - Issue - p S32
Supplement Abstracts Submitted for the 70th Annual Scientific Meeting of the American College of Gastroenterology: ESOPHAGUS
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Gastroenterology, Woodhull Medical Center, Brooklyn, NY.

Purpose: Persistent post-operative dysphagia is common in patients who undergo antireflux operations. In order to avoid post-operative dysphagia the operation has been tailored according to the preoperative esophageal manometric findings at the cost of decreased efficacy. To evaluate and compare the incidence and severity of dysphagia in patients with ineffective esophageal motility who underwent either a Toupet or Nissen fundoplication VERSUS patients with normal esophageal motility who underwent a Nissen fundoplication

Methods: A retrospective review was done of 47 patients who underwent a laparascopic antireflux procedure over a 4 year period. Among these 10 patients had ineffective esophageal motility. 5 of them had a Nissen and the other 5 had a Toupet procedure. These 10 patients were compared with 10 other patients with normal esophageal body motility who underwent a Nissen procedure. All patients were interviewed post operatively after an interval of 4–6 years. Their symptoms were recorded on a dysphagia score ranging from 0–13

Results: Among the 5 patients with ineffective motility who underwent a Nissen fundoplication 0(0%) complained of dysphagia, average score 0.8 and maximum score 1. Among the 5 patients with ineffective motility who underwent a Toupet fundoplication 3(60%) complained of dysphagia, average score 3.6 and maximum score 6. Among the 10 patients with normal esophageal motility who underwent a Nissen fundoplication 2(20%) complained of dysphagia, average score 1.2 and maximum score of 3.

Conclusions: Laparascopic Nissen fundoplication can be safely performed in patients with ineffective esophageal motility and the antireflux procedure does not have to be modified on the basis of preoperative esophageal body motility.

© The American College of Gastroenterology 2005. All Rights Reserved.